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J96.20 ICD-10-CM Code: Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
7 Excludes1
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 84

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 189 — PULMONARY EDEMA AND RESPIRATORY FAILURE (MDC 04)
  • MS-DRG 928 — FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC (MDC 22)
  • MS-DRG 929 — FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC (MDC 22)

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.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for J96.20 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on J96.20 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from J96

Coder workflow for J96.20

MedCoder structured workflow — derived from this code’s own official record

Before you code J96.20

  1. Unspecified does not mean incorrect. When the record gives no greater specificity, J96.20 may be the appropriate code. Check the record for detail that supports a more specific sibling — in this subcategory the siblings differ by acute versus chronic, the presence or absence of the associated condition. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

    ReviewJ96.21, J96.22

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. J96.20’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

  3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with J96.20. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — J96.20 is appropriate when the documentation goes no further.

    ReviewJ96.21, J96.22

  2. Does the documentation support a condition named in J96.20’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewJ80, R09.2, P22.0, J95.82, P28.81, P28.5

Consider J96.20. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Acuity
Acute or chronic as documented; when both are documented and separate codes exist, both are reported with the acute code first (Guidelines I.B.8).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting J96.20(7 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with J96.20: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareJ80, R09.2, P22.0, J95.82, P28.81, P28.5

    See the official tabular notes · Guidelines I.A.12.a

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the specific siblings in this subcategory and what each requires the record to state.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

ReviewJ96.21, J96.22

Documentation: Both the condition J96.20 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewJ80, R09.2, P22.0, J95.82, P28.81, P28.5

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is J96.20 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia is a billable ICD-10-CM diagnosis code (J96.20).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 10: Diseases of the Respiratory System (J00-J99), U07.0 a. Chronic Obstructive Pulmonary Disease [COPD] and Asthma 1) Acute exacerbation of chronic obstructive bronchitis and asthma

1) Acute respiratory failure as principal diagnosis A code from subcategory J96.0, Acute respiratory failure, or subcategory J96.2, Acute and chronic respiratory failure, may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital, and the selection is supported by the Alphabetic Index and Tabular List. However, chapter- specific coding guidelines (such as obstetrics, poisoning, HIV, newborn) that provide sequencing direction take precedence.

Verify Before Coding

  • MCC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name J96.20 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 2 Excludes1 notes: R06 — Abnormalities of breathing (via J96.-), R09 — Other symptoms and signs involving the circulatory and respiratory system (via J96.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 1 Excludes2 note: J95.82 — Postprocedural respiratory failure (via J96.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Code Also instruction: E87.20 — Acidosis, unspecified (via J96.-).

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: MCC — Major Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 22 clinically related codes on its CMS exclusion list. Does not count toward severity when the stay groups to DRGs 928-929 (Full Thickness Burn with Skin Graft or Inhalation Injury).

Named in the grouper logic of 3 MS-DRGs: DRG 189 (MDC 04), DRG 928 (MDC 22), DRG 929 (MDC 22).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):RSP012 — Respiratory failure; insufficiency; arrest (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as MCC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

J22 — Unspecified acute lower respiratory infection, J80 — Acute respiratory distress syndrome, 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, J96.10 — Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, J96.11 — Chronic respiratory failure with hypoxia, J96.12 — Chronic respiratory failure with hypercapnia, J96.21 — Acute and chronic respiratory failure with hypoxia, J96.22 — Acute and chronic respiratory failure with hypercapnia, J96.90 — Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia, J96.91 — Respiratory failure, unspecified with hypoxia, J96.92 — Respiratory failure, unspecified with hypercapnia, J98.8 — Other specified respiratory disorders, J98.9 — Respiratory disorder, unspecified, N80.B1 — Endometriosis of pleura, N80.B2 — Endometriosis of lung, N80.B31 — Superficial endometriosis of diaphragm, N80.B32 — Deep endometriosis of diaphragm, N80.B39 — Endometriosis of diaphragm, unspecified depth, +1 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Cardio-Respiratory Failure and Shock) for risk-adjusted payment.

I49.01 — Ventricular fibrillation, I49.02 — Ventricular flutter, J80 — Acute respiratory distress syndrome, J81.0 — Acute pulmonary edema, 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, J96.10 — Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, J96.11 — Chronic respiratory failure with hypoxia, J96.12 — Chronic respiratory failure with hypercapnia, J96.21 — Acute and chronic respiratory failure with hypoxia, J96.22 — Acute and chronic respiratory failure with hypercapnia, J96.90 — Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia, J96.91 — Respiratory failure, unspecified with hypoxia, J96.92 — Respiratory failure, unspecified with hypercapnia, P22.0 — Respiratory distress syndrome of newborn, P26.0 — Tracheobronchial hemorrhage originating in the perinatal period, P26.1 — Massive pulmonary hemorrhage originating in the perinatal period, P26.8 — Other pulmonary hemorrhages originating in the perinatal period, P26.9 — Unspecified pulmonary hemorrhage originating in the perinatal period, +15 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Respirator Dependence/Tracheostomy Status/Complications, Respiratory Arrest

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Respiratory failure; insufficiency; arrest).

J80 — Acute respiratory distress syndrome, J95.821 — Acute postprocedural respiratory failure, J95.822 — Acute and chronic postprocedural respiratory failure, 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, J96.10 — Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, J96.11 — Chronic respiratory failure with hypoxia, J96.12 — Chronic respiratory failure with hypercapnia, J96.21 — Acute and chronic respiratory failure with hypoxia, J96.22 — Acute and chronic respiratory failure with hypercapnia, J96.90 — Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia, J96.91 — Respiratory failure, unspecified with hypoxia, J96.92 — Respiratory failure, unspecified with hypercapnia, R09.2 — Respiratory arrest

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Failure, failed”; these codes share that main term but sit in a different category of the Tabular List.

I50.84 — End stage heart failure (heart, end stage), I50.89 — Other heart failure (heart, specified NEC), I50.9 — Heart failure, unspecified (heart), I67.9 — Cerebrovascular disease, unspecified (cerebrovascular), I70.90 — Unspecified atherosclerosis (heart, arteriosclerotic), I97.13 — Postprocedural heart failure (heart, postprocedural), I97.130 — Postprocedural heart failure following cardiac surgery (heart, following cardiac surgery), I97.131 — Postprocedural heart failure following other surgery (heart, following other surgery), J95.821 — Acute postprocedural respiratory failure (respiration, respiratory, postprocedural), J95.822 — Acute and chronic postprocedural respiratory failure (respiration, respiratory, postprocedural, acute and chronic), K70.40 — Alcoholic hepatic failure without coma (hepatic, alcoholic), K70.41 — Alcoholic hepatic failure with coma (hepatic, alcoholic, with coma), K71.10 — Toxic liver disease with hepatic necrosis, without coma (hepatic, due to drugs), K71.11 — Toxic liver disease with hepatic necrosis, with coma (hepatic, due to drugs, with coma), K72.00 — Acute and subacute hepatic failure without coma (hepatic, acute or subacute), K72.01 — Acute and subacute hepatic failure with coma (hepatic, acute or subacute, with coma), K72.10 — Chronic hepatic failure without coma (hepatic, chronic), K72.11 — Chronic hepatic failure with coma (hepatic, chronic, with coma), K72.90 — Hepatic failure, unspecified without coma (hepatic), K72.91 — Hepatic failure, unspecified with coma (hepatic, with coma), +119 more

Contextual Map

Every relationship of J96.20 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run J96.20 with these 4 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Referenced by Code Also instructions

  • E87.20 — Acidosis, unspecified[Code Also](via J96.-): “, if applicable, respiratory failure with hypercapnia (J96. with 5th character 2)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 213 — Cardio-Respiratory Failure and Shock [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 04 — Diseases and Disorders of the Respiratory System[MDC crossing]: “Diseases and Disorders of the Respiratory System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 3,998 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026
  • MDC 22 — Burns[MDC crossing]: “Burns — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 377 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Failure, failed, respiration, respiratory, acute andchronic (on)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (16)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "J96.20 — Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/j96.20-acute-and-chronic-respiratory-failure-unspecified-whether-with-hypoxia-or-hypercapnia

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to J96.20 in its code family, with their registry titles.

View all codes in the J96 family