J96.9 ICD-10-CM Code: Respiratory failure, unspecified
J96.9 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Other diseases of the respiratory system (J96-J99)
J96.9
Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidanceRespiratory failure, unspecified
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for J96.9. 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
- certain infectious and parasitic diseases (A00-B99)Inherited from J00-J99
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from J00-J99
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from J00-J99
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from J00-J99
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from J00-J99
- neoplasms (C00-D49)Inherited from J00-J99
- smoke inhalation (T59.81-)Inherited from J00-J99
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from J00-J99
Related Codes
Includes
OfficialNo Includes notes are included in this display for J96.9. Check the code and parent instructions in the Code Book.
Excludes 1
Official- acute respiratory distress syndrome (J80)Inherited from J96
- cardiorespiratory failure (R09.2)Inherited from J96
- newborn respiratory distress syndrome (P22.0)Inherited from J96
- postprocedural respiratory failure (J95.82-)Inherited from J96
- respiratory arrest (R09.2)Inherited from J96
- respiratory arrest of newborn (P28.81)Inherited from J96
- respiratory failure of newborn (P28.5)Inherited from J96
Code First
OfficialNo Code First sequencing instructions are included in this display for J96.9. 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 J96.9. Check the code and parent instructions in the Code Book.
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 →
- Code
- J96.9
- Description
- Respiratory failure, unspecified
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- No
- Payment year
- 2026
Coder workflow notes
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What This Code Means
J96.9 is the ICD-10-CM diagnosis code for respiratory failure, unspecified. J96.9 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering other diseases of the respiratory system (j96-j99).
Header codes like J96.9 cannot be reported on claims directly; they organize child codes that share clinical context. Coders should select the billable child code that matches the documented presentation and then verify its current source-backed HCC mapping. Do not infer a child code or risk adjustment value from the header alone.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for J96.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.