2026 ICD-10-CM Diagnosis Code J95.03Malfunction of tracheostomy stoma
ICD-10-CM Codes›J00–J99›J95›J95
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 211
- Not Chronic
J95.03 is a billable ICD-10-CM diagnosis code for malfunction of tracheostomy stoma. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 11 through 13, 205 through 206. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 12 closely related codes. Coders also document this condition as malfunction of tracheostomy. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Postprocedural or postoperative respiratory system complication.
For Medicare Advantage risk adjustment, J95.03 maps to CMS-HCC Category 211 (Respirator Dependence/Tracheostomy Status/Complications) under the V28 model, adding a risk factor of about 0.879 for a community, non-dual, aged beneficiary in payment year 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
J95.03 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.
Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Malfunction of tracheostomy
- Stenosis of trachea
- Stomal obstruction
- Tracheal stenosis following tracheostomy
- Tracheostomy complication
- Tracheostomy obstruction
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Inclusion Terms
- Mechanical complication of tracheostomy stoma
- Obstruction of tracheostomy airway
- Tracheal stenosis due to tracheostomy
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
malfunction J95.03
mechanical J95.03
obstruction J95.03
Malfunction See Also: Dysfunction;
tracheostomy J95.03
Stenosis, stenotic (cicatricial) See Also: Stricture;
tracheostomy J95.03
tracheostomy J95.03
Stricture See Also: Stenosis;
tracheostomy J95.03
tracheostomy J95.03
malfunctioning J95.03
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Tracheal Disorders
Your trachea, or windpipe, is one part of your airway system. Airways are pipes that carry oxygen-rich air to your lungs. They also carry carbon dioxide, a waste gas, out of your lungs.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert J95.03 to ICD-9-CMHistory
Code HistoryHistory
Questions About J95.03Overview
What is the ICD-10 code for malfunction of tracheostomy stoma?
The ICD-10-CM code for malfunction of tracheostomy stoma is J95.03 (sometimes written as J9503). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is J95.03 (Tracheostomy complications) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report malfunction of tracheostomy stoma on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does J95.03 group to?
When malfunction of tracheostomy stoma is the principal diagnosis on an inpatient stay, it groups to MS-DRG 11, 12, 13, 205, 206, with relative weights from 0.9411 to 5.4541 depending on complications. Higher weights mean higher Medicare reimbursement.
Is J95.03 a CC or MCC?
CMS lists J95.03 as a CC (complication or comorbidity) for FY 2026. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 12 closely related codes in its exclusion list.
What is the ICD-9 equivalent of J95.03?
Under the General Equivalence Mappings, malfunction of tracheostomy stoma converts to ICD-9-CM 519.02 (tracheostomy - mech comp) and 519.09 (tracheostomy comp NEC). The mapping is approximate, so confirm the match fits the documentation.
What HCC is J95.03?
J95.03 (malfunction of tracheostomy stoma) maps to CMS-HCC Category 211 (Respirator Dependence/Tracheostomy Status/Complications), commonly written as HCC 211, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 82 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does J95.03 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, J95.03 adds a risk adjustment factor of about 0.879 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.590 to 1.981 depending on the payment segment). HCC 211 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 211 category page.
