J96.11 ICD-10-CM Code: Chronic respiratory failure with hypoxia
Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.
Inpatient Payment Groups (MS-DRG)
MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0 (FY2026), Appendix B.
- MS-DRG 189 — PULMONARY EDEMA AND RESPIRATORY FAILURE (MDC 04)
A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.
Risk Adjustment (CMS-HCC)
Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.
- HCC 213 — Cardio-Respiratory Failure and Shock
Other models: CMS-HCC V22 HCC 84
Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.
Official Registry Overview & Definition
Official Tabular Instructional Notes
Sequencing, inclusion, and exclusion notes published for J96.11 in the official ICD-10-CM tabular list.
Excludes1 — Not Coded Here
Conditions that can never be reported with this code; the two are mutually exclusive.
- acute respiratory distress syndrome (J80)
- cardiorespiratory failure (R09.2)
- newborn respiratory distress syndrome (P22.0)
- postprocedural respiratory failure (J95.82-)
- respiratory arrest (R09.2)
- respiratory arrest of newborn (P28.81)
- respiratory failure of newborn (P28.5)
Nearest Codes in This Family
Official ICD-10-CM classifications closest to J96.11 in its code family, with their registry titles.
- J96.00 — Acute respiratory failure, unspecified whether with hypoxia or hypercapnia
- J96.01 — Acute respiratory failure with hypoxia
- J96.02 — Acute respiratory failure with hypercapnia
- J96.1 — Chronic respiratory failure
- J96.10 — Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia
- J96.12 — Chronic respiratory failure with hypercapnia
- J96.2 — Acute and chronic respiratory failure
- J96.20 — Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia
- J96.21 — Acute and chronic respiratory failure with hypoxia
- J96.22 — Acute and chronic respiratory failure with hypercapnia
Indexed Clinical Terms (1)
Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code.
- Failure, failed, respiration, respiratory, chronic, with, hypoxia