2026 ICD-10-CM Diagnosis Code J95.04Tracheo-esophageal fistula following tracheostomy

ICD-10-CM Codes›J00–J99›J95›J95

ICD-10-CM J95.04
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

J95.04 is a billable ICD-10-CM diagnosis code for tracheo-esophageal fistula following tracheostomy. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 205 through 206. Coders also document this condition as postoperative fistula. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Postprocedural or postoperative respiratory system complication.

Code Identity

ICD-10-CM Code
J95.04
Billable Status
Yes — Valid for Submission
Code Describes
Tracheo-esophageal fistula following tracheostomy
Short Description
Tracheo-esophageal fistula following tracheostomy
Same as the full description in the CMS dataset.
Parent Code
J95.0
Tracheostomy complications

Code Classification

ChapterJ00–J99Diseases of the respiratory system
SectionJ95Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified
CategoryJ95Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified
This CodeJ95.04Tracheo-esophageal fistula following tracheostomy

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Postoperative fistula
  • Tracheoesophageal fistula
  • Tracheoesophageal fistula following tracheostomy
  • Tracheostomy complication

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

External Cause of Injuries IndexGuidance

References for this code in the External Cause of Injuries Index.

    • Complication(s) (from) (of)
      • tracheostomy
        • tracheo-esophageal fistula
    • Fistula(cutaneous)
      • tracheoesophageal
        • following tracheostomy

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR RSP017
Postprocedural or postoperative respiratory system complication
Default principal diagnosis: inpatient Yes · outpatient Yes

Clinical InformationClinical

  • Tracheoesophageal Fistula

    abnormal passage between the esophagus and the trachea, acquired or congenital, often associated with esophageal atresia.

Patient EducationClinical

Fistulas

A fistula is an abnormal connection between two parts inside of the body. Fistulas may develop between different organs, such as between the esophagus and the windpipe or the bowel and the vagina. They can also develop between two blood vessels, such as between an artery and a vein or between two arteries.

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert J95.04 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
519.09 Tracheostomy comp NEC
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About J95.04Overview

Is J95.04 (Tracheostomy complications) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report tracheo-esophageal fistula following tracheostomy on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does J95.04 group to?

When tracheo-esophageal fistula following tracheostomy is the principal diagnosis on an inpatient stay, it groups to MS-DRG 205, 206, with relative weights from 0.9411 to 1.8310 depending on complications. Higher weights mean higher Medicare reimbursement.

What is the ICD-9 equivalent of J95.04?

Under the General Equivalence Mappings, tracheo-esophageal fistula following tracheostomy converts to ICD-9-CM 519.09 (tracheostomy comp NEC). The mapping is approximate, so confirm the match fits the documentation.

Footnotes

[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.