This document provides guidance on coding respiratory failure. It defines the types of respiratory failure coded in ICD-10 category J96 based on whether it is acute, chronic, or unspecified and whether there is accompanying hypercapnia or hypoxia. It also outlines the official guidelines for coding acute respiratory failure as the principal or secondary diagnosis depending on the circumstances of admission. Two case examples are provided to demonstrate how to determine if respiratory failure should be coded as hypercapnic or hypoxic based on the documented clinical findings.

1. MDC 4
DISEASES & DISORDERS OF THE
RESPIRATORY SYSTEM
I-10 CDI Education the Makes a Difference

2. Respiratory Failure;
your diagnostic options at a glance
J96 is the category that captures your patient’s diagnosis of
respiratory failure
In this category, the ④th character specifies the type of
respiratory failure
*acute *acute and chronic
*chronic *unspecified
The ⑤th character identifies whether your
patient has concomitant hypercapnia or
hypoxia

3. Respiratory Failure
Hypercapnia vs Hypoxia
• Hypoxemic respiratory failure is characterized by an arterial
oxygen tension (Pa O2) lower than 60 mm Hg with a normal or
low arterial carbon dioxide tension (Pa CO2). This is the most
common form of respiratory failure and is associated with
pulmonary edema, pneumonia, and PE.
• Hypercapnic respiratory failure is characterized by a PaCO2
higher than 50 mm Hg. This form of respiratory failure is
common with COPD, drug overdose, and neuromuscular
diseases.

4. Acute Respiratory Failure
Official Guidelines
Acute respiratory failure as principal diagnosis
o Acute respiratory failure, or Acute and chronic respiratory failure, may
be assigned as principal diagnosis when it is the condition established
after study to be chiefly responsible for occasioning the admission to the
hospital.
o However, chapter specific coding guidelines (such as obstetrics,
poisoning, HIV, newborn) provide sequencing direction take precedence.
Acute respiratory failure as secondary diagnosis
o Respiratory failure may be listed as a secondary diagnosis if it occurs
after admission, or if it is present on admission, but does not meet the
definition of principal diagnosis.

5. Acute Respiratory Failure
Official Guidelines
Sequencing of acute respiratory failure and another acute condition
o When a patient is admitted with respiratory failure and another acute
condition, e.g., myocardial infarction, cerebrovascular accident,
aspiration pneumonia, the principal diagnosis will not be the same in
every situation.
o This applies whether the other acute condition is a respiratory or
nonrespiratory condition.
o Selection of the principal diagnosis will be dependent on the
circumstances of admission.
o If both the respiratory failure and the other acute condition are equally
responsible for occasioning the admission to the hospital, and there are
no chapter-specific sequencing rules, the guideline regarding two or
more diagnoses that equally meet the definition for principal diagnosis
o If the documentation is not clear as to whether acute respiratory failure
and another condition are equally responsible for occasioning the
admission, query the provider for clarification.

6. Respiratory Failure;
I-10 Documentation Management Pearls
Don’t be satisfied with a diagnosis of “respiratory failure”
– work with your physician to establish the type
Review your Guidelines!
If the clinical presentation supports either hypercapnia or
hypoxia but it is not documented – ask the question!
I-10 Checklist
TYPE
HYPERCAPNIA
HYPOXIA

7. The medical record reflects the
following clinical findings, treatment,
and risk factors.
78 yo female admitted with severe
labrynthitis, N/V and decreased PO
intake x2 days; assessment reveals
dry mucus membranes, poor skin
turgor, decreased urine output for 24
hours, BUN at 52
Treatment: 500 cc IVF bolus, IVFs at
125cc/hr, serial lab monitoring, strict
I&O, electrolyte replacement
I-10 University Hospital

8. Triage NN: a 68 yo male presents to the ED
with severe shortness of breath – he is
diaphoretic and unable to speak in full
sentences
VS: 156/92, P92, R28, T100.3.2, 02 sat at
86% on RA
PMH: COPD
Meds: albuterol breathing treatments
Diagnostics: CXR + for LUL infiltrate
Impressions:
ED: pneumonia with low 02 sats
H&P: 68 yo male presents with pneumonia
and acute respiratory failure – 02 sats ranging
from 88-91% on BiPAP – will monitor closely
for fatigue – pulmonary consult pending
TestYourRetention:
RespiratoryFailure
I-10 Checklist
TYPE
HYPERCAPNIA
HYPOXIA

9. Test Your Retention:
Respiratory Failure
What’s the missing piece of documentation for
the patient’s respiratory failure?
If the acute respiratory failure is d/t a
phenobarbital overdose, can you
assign the respiratory failure as PDx?

10. Test Your Retention:
Respiratory Failure
What’s the missing piece of documentation for the
patient’s respiratory failure diagnosis?
Any concomitant hypercapnia or hypoxia
If the acute respiratory failure is d/t a phenobarbital overdose,
can you assign the respiratory failure as PDx?
No; see your Official Guidelines for respiratory failure