2027 ICD-10-CM Diagnosis Code J95.859Other complication of respirator [ventilator]
ICD-10-CM Codes›J00–J99›J95›J95
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 211
- Not Chronic
J95.859 is a billable ICD-10-CM diagnosis code for other complication of respirator [ventilator]. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 205 through 206, 791, 793. 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 55 closely related codes. Coders also document this condition as complication of respiratory therapy procedure. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Postprocedural or postoperative respiratory system complication.
For Medicare Advantage risk adjustment, J95.859 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 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
J95.859 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 2027.
Source: CMS Payment Year 2027 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.
- Complication of respiratory therapy procedure
- Ventilator-associated lung injury
- Ventilator-induced diaphragmatic dysfunction
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to J95.859: its own notes plus those printed at J95 and Chapter 10. A note printed at a category, block or chapter applies to every code under it.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- smoke inhalation (T59.81-)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Notes
General instructions on how these codes are used.
- When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name J95.859, its category, or a range that includes it.
Excludes2 1
These codes carry an Excludes2 note naming J95.859: its condition is not part of those codes, and both may be reported when the patient has both.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
specified NEC J95.859
specified NEC J95.859
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Convert J95.859 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About J95.859Overview
What is the ICD-10 code for other complication of respirator [ventilator]?
The ICD-10-CM code for other complication of respirator [ventilator] is J95.859 (sometimes written as J95859). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is J95.859 (Complication of respirator [ventilator]) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report other complication of respirator [ventilator] on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does J95.859 group to?
When other complication of respirator [ventilator] is the principal diagnosis on an inpatient stay, it groups to MS-DRG 793, 791, 206, 205, with relative weights from 0.9255 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Is J95.859 a CC or MCC?
CMS lists J95.859 as a CC (complication or comorbidity) for FY 2027. 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 55 closely related codes in its exclusion list.
What is the ICD-9 equivalent of J95.859?
Under the General Equivalence Mappings, other complication of respirator [ventilator] converts to ICD-9-CM 997.39 (respiratory comp NEC). The mapping is approximate, so confirm the match fits the documentation.
What HCC is J95.859?
J95.859 (other complication of respirator [ventilator]) 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 2027. 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 J95.859 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, J95.859 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.
