J95.00 ICD-10-CM Code: Unspecified tracheostomy complication
J95.00 maps to CMS-HCC V28 211. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified (J95)
J95.00
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceUnspecified tracheostomy complication
A problem or complication related to a tracheostomy (surgical opening in the windpipe) that is not further specified.
Buddy Insight
Unspecified tracheostomy complication indicates a problem related to a tracheostomy that is not further categorized.
CMS-HCC V28
MappedHCC 211
Coefficient HCC 211: 0.879 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 125
Code-level coefficient reference
ESRD/PACE
MappedHCC 82
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for J95.00. Check the code and parent instructions in the Code Book.
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from J00-J99, J95
- certain infectious and parasitic diseases (A00-B99)Inherited from J00-J99, J95
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from J00-J99, J95
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from J00-J99, J95
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from J00-J99, J95
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from J00-J99, J95
- neoplasms (C00-D49)Inherited from J00-J99, J95
- smoke inhalation (T59.81-)Inherited from J00-J99, J95
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from J00-J99, J95
- aspiration pneumonia (J69.-)Inherited from J00-J99, J95
- emphysema (subcutaneous) resulting from a procedure (T81.82)Inherited from J00-J99, J95
- hypostatic pneumonia (J18.2)Inherited from J00-J99, J95
- pulmonary manifestations due to radiation (J70.0-J70.1)Inherited from J00-J99, J95
Related Codes
Includes
OfficialNo Includes notes are included in this display for J95.00. Check the code and parent instructions in the Code Book.
Excludes 1
OfficialNo Excludes 1 notes are included in this display for J95.00. Check the code and parent instructions in the Code Book.
Code First
OfficialNo Code First sequencing instructions are included in this display for J95.00. Check the code and parent instructions in the Code Book.
Use Additional
Official- code, where applicable, to identify:Inherited from J00-J99
- exposure to environmental tobacco smoke (Z77.22)Inherited from J00-J99
- exposure to tobacco smoke in the perinatal period (P96.81)Inherited from J00-J99
- history of tobacco dependence (Z87.891)Inherited from J00-J99
- occupational exposure to environmental tobacco smoke (Z57.31)Inherited from J00-J99
- tobacco dependence (F17.-)Inherited from J00-J99
- tobacco use (Z72.0)Inherited from J00-J99
Code Also
OfficialNo Code Also instructions are included in this display for J95.00. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is J95.00 an HCC code?
Yes. J95.00 (Unspecified tracheostomy complication) maps to HCC 211, Respirator Dependence/Tracheostomy Status/Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.879. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: J95.00 is billable and maps to V28 HCC 211, Respirator Dependence/Tracheostomy Status/Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- J95.00
- Description
- Unspecified tracheostomy complication
- HCC (V28)
- HCC 211 — Respirator Dependence/Tracheostomy Status/Complications
- RAF reference coefficient
- 0.879
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work J95.00 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for J95.00
For J95.00, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Coder workflow notes
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What This Code Means
J95.00 is the ICD-10-CM diagnosis code for unspecified tracheostomy complication. A problem or complication related to a tracheostomy (surgical opening in the windpipe) that is not further specified. J95.00 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified (j95).
Under the CMS-HCC V28 risk adjustment model, J95.00 maps to Respirator Dependence/Tracheostomy Status/Complications (HCC 211) with a source-labeled community, non-dual, aged reference coefficient of 0.879. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Review the clinical documentation to identify the specific type of complication if possible. For J95.00, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for J95.00 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Review the clinical documentation to identify the specific type of complication if possible
- •Use more specific J95.0x codes if the complication type is documented
Clinical Significance
Unspecified tracheostomy complication indicates a problem related to a tracheostomy that is not further categorized. The presence of a tracheostomy itself indicates significant medical complexity, and any complication adds to that burden. This code captures risk adjustment value for the tracheostomy status while indicating an additional complication requiring management.
Documentation Requirements
- ✓Documentation of an active tracheostomy
- ✓Description of the complication, even if not fitting specific subcategories
- ✓Assessment of tracheostomy site and function
- ✓Treatment plan for the identified complication
- ✓Consider querying the provider for more specific documentation to enable use of a more specific J95.0x code
Commonly Confused Codes
- •J95.01: Hemorrhage from tracheostomy stoma is more specific for bleeding complications
- •J95.02: Infection of tracheostomy stoma is more specific for infectious complications
- •J95.03: Malfunction of tracheostomy stoma is more specific for functional problems
- •Z93.0: Tracheostomy status is used when there is NO complication, just status documentation