J96.01

Billable

Acute respiratory failure with hypoxia

HCC Category Mapping

V28HCC 213 — Cardio-Respiratory Failure and Shock

0.000

V24HCC 84 — Cardio-Respiratory Failure and Shock

0.402

ESRDHCC 84 — Cardio-Respiratory Failure and Shock

0.000

What This Code Means

A sudden, life-threatening condition where the lungs cannot provide enough oxygen to the blood, causing dangerously low oxygen levels in the body.

Coding Tips

•This code requires documentation of acute onset and confirmed hypoxia (low blood oxygen); verify arterial blood gas (ABG) results in the medical record
•Do not use this code if the respiratory failure is chronic or if hypercapnia (high CO2) is the primary concern instead

Clinical Significance

Acute respiratory failure with hypoxia is a life-threatening condition where the lungs cannot maintain adequate blood oxygen levels. This is the most common form of respiratory failure, often caused by pneumonia, ARDS, pulmonary embolism, or acute exacerbation of chronic lung disease. The specific documentation of hypoxia (Type 1 respiratory failure) guides treatment with oxygen supplementation and positive-pressure ventilation.

Documentation Requirements

✓Provider documentation explicitly stating acute respiratory failure with hypoxia
✓ABG results showing PaO2 < 60 mmHg on room air or clinical evidence of severe hypoxemia
✓Documentation of acute onset (not chronic or acute-on-chronic)
✓Underlying cause identified and coded separately
✓Treatment plan including oxygen delivery method, FiO2, ventilatory support if needed

Commonly Confused Codes

J96.02 — Acute respiratory failure with hypercapnia is Type 2 failure with high CO2, not low oxygen J96.00 — Acute respiratory failure unspecified should not be used when hypoxia is clearly documented J96.11 — Chronic respiratory failure with hypoxia is for long-standing, not acute, hypoxemic failure J96.21 — Acute and chronic respiratory failure with hypoxia is for patients with baseline chronic failure experiencing acute worsening

Code Hierarchy

└J96Respiratory failure, not elsewhere classified └J96.0Acute respiratory failure └J96.01Acute respiratory failure with hypoxia

└J96.01Acute respiratory failure with hypoxia