Acute Hypoxic Respiratory Failure ICD-10 Code: J96.01

The ICD-10 code for acute hypoxic respiratory failure is J96.01 (Acute respiratory failure with hypoxia). This code is used when the patient has acute respiratory failure characterized by low oxygen levels (hypoxemia) without significant carbon dioxide retention.

Understanding Respiratory Failure Types

ICD-10-CM classifies respiratory failure by both acuity and type:

J96 Code Family

Sequencing Respiratory Failure

Respiratory failure sequencing depends on the circumstances of admission:

Respiratory failure as primary:

• When the patient is admitted specifically for respiratory failure
• When respiratory failure is present on admission and is the main reason for care

Respiratory failure as secondary:

• When another condition (pneumonia, COPD exacerbation, sepsis) is the primary reason and respiratory failure is a complication

Per ICD-10-CM guidelines, either sequencing may be appropriate depending on documentation and circumstances. Chapter-specific guidelines may provide additional direction (e.g., sepsis coding rules).

Common Coding Scenarios

Scenario 1: Acute Hypoxic Respiratory Failure from Pneumonia

Documentation: "Acute hypoxic respiratory failure due to community-acquired pneumonia. Patient requiring high-flow oxygen."

Codes:

• J96.01 (Acute respiratory failure with hypoxia)
• J18.9 (Pneumonia, unspecified organism)

Rationale: Sequence based on circumstances. If admitted for respiratory failure, it may be primary. The pneumonia is coded as the underlying cause.

Scenario 2: COPD Exacerbation with Acute Hypoxic Respiratory Failure

Documentation: "COPD exacerbation with acute hypoxic respiratory failure."

Codes:

• J44.1 (Chronic obstructive pulmonary disease with acute exacerbation)
• J96.01 (Acute respiratory failure with hypoxia)

Rationale: COPD codes have an instructional note to "Use additional code" for respiratory failure. Either sequencing may be acceptable depending on circumstances.

Scenario 3: Post-operative Respiratory Failure

Documentation: "Post-operative acute hypoxic respiratory failure following hip replacement. Requiring mechanical ventilation."

Codes:

• J95.821 (Acute postprocedural respiratory failure)
• J96.01 (Acute respiratory failure with hypoxia) - may also be needed for specificity

Rationale: For post-procedural respiratory failure, there's a specific code. However, some coders also add J96.01 for the type of respiratory failure.

Scenario 4: Acute on Chronic Hypoxic Respiratory Failure

Documentation: "Acute on chronic hypoxic respiratory failure. Known chronic respiratory failure from interstitial lung disease."

Code: J96.21 (Acute and chronic respiratory failure with hypoxia)

Rationale: When a patient with chronic respiratory failure has acute worsening, use the combined code.

Scenario 5: Respiratory Failure Type Not Specified

Documentation: "Acute respiratory failure. On 6L NC."

Code: J96.00 (Acute respiratory failure, unspecified)

Rationale: If documentation doesn't specify hypoxic or hypercapnic, query for specificity. If not clarified, use unspecified code.

Mechanical Ventilation Coding

When respiratory failure requires mechanical ventilation, also code:

• Procedure code for mechanical ventilation (ICD-10-PCS)
• Duration affects MS-DRG assignment in inpatient settings (≥96 hours vs <96 hours)

Documentation Requirements

For accurate respiratory failure coding, documentation should include:

• Acuity: acute, chronic, or acute on chronic
• Type: hypoxic (Type I), hypercapnic (Type II), or both
• Objective data: PaO2, PaCO2, SpO2, oxygen requirements
• Underlying cause: pneumonia, COPD, sepsis, etc.
• Interventions: oxygen therapy, mechanical ventilation, BiPAP

Query Opportunities

Consider querying when:

• Documentation says "respiratory failure" without specifying acute vs chronic
• ABG shows hypoxemia but "respiratory failure" not documented
• Patient on high oxygen requirements without respiratory failure diagnosis
• Documentation unclear about whether hypoxic, hypercapnic, or both