What is ICD-10 code J95.01?

J95.01 is the ICD-10-CM diagnosis code for Hemorrhage from tracheostomy stoma. Bleeding that occurs from the opening (stoma) created in the windpipe during a tracheostomy procedure. This is a complication that can happen when the tracheostomy tube irritates or damages blood vessels in the area. J95.01 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. J95.01 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. J95.01 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. J95.01 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for J95.01?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For J95.01, V28 maps to Respirator Dependence/Tracheostomy Status/Complications at RAF 0.879 while V24 mapped to Respirator Dependence/Tracheostomy Status at RAF 1.000. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting J95.01?

This code should only be used when bleeding is specifically documented as originating from the tracheostomy stoma site, not from other respiratory tract locations Verify the tracheostomy is present and active; if the stoma has been closed or the patient no longer has a tracheostomy, this code would not be appropriate Because J95.01 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM J95.01: Hemorrhage

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Code lookupJ95.01Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified (J95)

J95.01

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Hemorrhage from tracheostomy stoma

Bleeding that occurs from the opening (stoma) created in the windpipe during a tracheostomy procedure. This is a complication that can happen when the tracheostomy tube irritates or damages blood vessels in the area.

Buddy Insight

Hemorrhage from tracheostomy stoma is a potentially life-threatening complication where bleeding occurs at the surgical opening in the trachea.

CMS-HCC V28

Mapped

HCC 211

Respirator Dependence/Tracheo...

RAF 0.879

CMS-HCC V24

Mapped

HCC 82

Respirator Dependence/Tracheo...

RAF 1.000

ACA/HHS

Mapped

HCC 125

HHS-HCC 125

Varies by metal level

ESRD/PACE

Mapped

HCC 82

Respirator Dependence/Tracheo...

RAF 0.161

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

J95Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified

J95.0Tracheostomy complications

J95.01Hemorrhage from tracheostomy stoma

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for J95.01 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for J95.01 in this effective period.

Related Child Codes

Official

J95.00Unspecified tracheostomy complication

J95.02Infection of tracheostomy stoma

J95.03Malfunction of tracheostomy stoma

J95.04Tracheo-esophageal fistula following tracheostomy

J95.09Other tracheostomy complication

Includes

Official

ICD-10-CM does not list Includes notes for J95.01 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for J95.01 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for J95.01 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for J95.01 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for J95.01 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of bleeding specifically from the tracheostomy stoma site

Severity of hemorrhage (minor oozing vs. significant bleeding vs. massive hemorrhage)

Assessment for underlying cause (granulation tissue, tube erosion, tracheo-innominate fistula, coagulopathy)

Treatment provided (local pressure, cauterization, surgical exploration, blood transfusion)

MEAT Support

HCC Buddy guidance

Documentation of bleeding specifically from the tracheostomy stoma site

Severity of hemorrhage (minor oozing vs. significant bleeding vs. massive hemorrhage)

Assessment for underlying cause (granulation tissue, tube erosion, tracheo-innominate fistula, coagulopathy)

Treatment provided (local pressure, cauterization, surgical exploration, blood transfusion)

Audit Caution

HCC Buddy guidance

Using the unspecified tracheostomy complication code (J95.00) when hemorrhage is clearly documented

Failing to assess for tracheo-innominate artery fistula in cases of significant tracheostomy bleeding — this is a surgical emergency

Not documenting whether the bleeding is from the stoma itself versus the tracheal lumen

Confusing with hemoptysis (R04.2) which is blood originating from the lower respiratory tract, not the stoma

Common Mistakes

HCC Buddy guidance

J95.00 — Unspecified tracheostomy complication is less specific and should not be used when hemorrhage is documented

J95.02 — Infection of tracheostomy stoma may co-exist with bleeding but is a different primary complication

R04.89 — Hemorrhage from other sites in respiratory passages is for bleeding not related to tracheostomy

T81.31XA — Disruption of wound of other part of respiratory system with hemorrhage is for non-tracheostomy surgical wound bleeding

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 J95.01 an HCC code?

Yes. J95.01 (Hemorrhage from tracheostomy stoma) maps to Respirator Dependence/Tracheostomy Status/Complications under the CMS-HCC V28 risk adjustment model (and Respirator Dependence/Tracheostomy Status under V24), with a community non-dual aged RAF of 0.879. It is billable for payment year 2026.

Coder answer: J95.01 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: J95.01
Description: Hemorrhage from tracheostomy stoma
HCC (V28): HCC 211 — Respirator Dependence/Tracheostomy Status/Complications
RAF: 0.879
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 211, Respirator Dependence/Tracheostomy Status/Complications

0.879

V24HCC 82, Respirator Dependence/Tracheostomy Status

1.000

ESRDHCC 82, Respirator Dependence/Tracheostomy Status

0.161

Each model's RAF is its CMS base weight for that model's standard population, so 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 segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

Work J95.01 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for J95.01

For J95.01 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

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

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed J95.01 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

J95.01 is the ICD-10-CM diagnosis code for hemorrhage from tracheostomy stoma. Bleeding that occurs from the opening (stoma) created in the windpipe during a tracheostomy procedure. This is a complication that can happen when the tracheostomy tube irritates or damages blood vessels in the area. J95.01 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, J95.01 maps to Respirator Dependence/Tracheostomy Status/Complications (HCC 211) with a community, non-dual, aged base RAF weight of 0.879. Under the older CMS-HCC V24 model, J95.01 maps to Respirator Dependence/Tracheostomy Status (HCC 82) with a community, non-dual, aged base RAF weight of 1.000. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

This code should only be used when bleeding is specifically documented as originating from the tracheostomy stoma site, not from other respiratory tract locations. Because J95.01 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for J95.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This code should only be used when bleeding is specifically documented as originating from the tracheostomy stoma site, not from other respiratory tract locations
•Verify the tracheostomy is present and active; if the stoma has been closed or the patient no longer has a tracheostomy, this code would not be appropriate

Clinical Significance

Hemorrhage from tracheostomy stoma is a potentially life-threatening complication where bleeding occurs at the surgical opening in the trachea. The severity ranges from minor stomal bleeding to catastrophic hemorrhage from tracheo-innominate artery fistula. This complication requires urgent evaluation and may necessitate surgical intervention, reflecting high acuity of care.

Documentation Requirements

✓Documentation of bleeding specifically from the tracheostomy stoma site
✓Severity of hemorrhage (minor oozing vs. significant bleeding vs. massive hemorrhage)
✓Assessment for underlying cause (granulation tissue, tube erosion, tracheo-innominate fistula, coagulopathy)
✓Treatment provided (local pressure, cauterization, surgical exploration, blood transfusion)
✓Active tracheostomy status documentation

Commonly Confused Codes

•J95.00: Unspecified tracheostomy complication is less specific and should not be used when hemorrhage is documented
•J95.02: Infection of tracheostomy stoma may co-exist with bleeding but is a different primary complication
•R04.89: Hemorrhage from other sites in respiratory passages is for bleeding not related to tracheostomy
•T81.31XA: Disruption of wound of other part of respiratory system with hemorrhage is for non-tracheostomy surgical wound bleeding