J95.2
BillableAcute pulmonary insufficiency following nonthoracic surgery
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is J95.2 an HCC code?
Yes. J95.2 maps to Cardio-Respiratory Failure and Shock under the V24 model but is not retained in V28.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for J95.2
For J95.2to 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 J95.2 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
J95.2 is the ICD-10-CM diagnosis code for acute pulmonary insufficiency following nonthoracic surgery. Sudden difficulty breathing or lung failure that occurs shortly after non-chest surgery (such as abdominal or orthopedic surgery). J95.2 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 older CMS-HCC V24 model, J95.2 maps to Cardio-Respiratory Failure and Shock (HCC 84) with a community, non-dual, aged base RAF weight of 0.282. 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.
Clearly document the relationship between the non-thoracic surgery and the pulmonary insufficiency. Because J95.2 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 J95.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Clearly document the relationship between the non-thoracic surgery and the pulmonary insufficiency
- •Code the primary surgical procedure separately to establish the causal relationship
Clinical Significance
Acute pulmonary insufficiency following nonthoracic surgery occurs when lung function deteriorates after surgery on areas other than the chest, such as abdominal, orthopedic, or neurological procedures. This can result from anesthesia effects, aspiration, atelectasis, or fluid overload. It indicates perioperative complexity requiring respiratory support and monitoring.
Documentation Requirements
- ✓Documentation of the specific non-thoracic surgical procedure
- ✓Timing confirming postoperative onset of pulmonary insufficiency
- ✓Clinical evidence of respiratory compromise (desaturation, tachypnea, abnormal ABG)
- ✓Assessment of the contributing cause (atelectasis, aspiration, fluid overload, pulmonary embolism)
- ✓Treatment plan including respiratory support measures
Excludes 2 — Not included here, may code separately
Commonly Confused Codes
- •J95.1 — Acute pulmonary insufficiency following thoracic surgery is for chest surgeries specifically
- •J95.821 — Acute postprocedural respiratory failure indicates more severe respiratory compromise
- •J95.3 — Chronic pulmonary insufficiency following surgery is for long-term post-surgical respiratory problems
- •J96.00 — Acute respiratory failure unspecified is not procedure-linked