2027 ICD-10-CM Diagnosis Code J96.90Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia
ICD-10-CM Codes›J00–J99›J96-J99›J96
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 213
- Not Chronic
J96.90 is a billable ICD-10-CM diagnosis code for respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 189, 928 through 929, 934. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 22 closely related codes. Coders also document this condition as absence of spontaneous respiration. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Respiratory failure; insufficiency; arrest.
For Medicare Advantage risk adjustment, J96.90 maps to CMS-HCC Category 213 (Cardio-Respiratory Failure and Shock) under the V28 model, adding a risk factor of about 0.370 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
J96.90 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.
- Absence of spontaneous respiration
- Congenital muscular dystrophy, respiratory failure, skin abnormalities, joint hyperlaxity syndrome
- Hereditary myopathy with early respiratory failure
- Proximal myopathy
- Respiratory failure
- Respiratory failure following trauma
- Sleep-related respiratory failure
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to J96.90: its own notes plus those printed at J96 and Chapter 10. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
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 J96.90, its category, or a range that includes it.
Excludes1 3
These codes carry an Excludes1 note naming J96.90: they are not reported together with it, unless the two conditions are unrelated.
- R06 Abnormalities of breathingrespiratory failure (J96.-) names J96.-, which includes this code
- R09 Other symptoms and signs involving the circulatory and respiratory systemrespiratory failure (J96.-) names J96.-, which includes this code
- R09.2 Respiratory arrestrespiratory failure (J96.-) names J96.-, which includes this code
Excludes2 1
These codes carry an Excludes2 note naming J96.90: 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.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Respiratory Failure
the significant impairment of gas exchange within the lungs resulting in hypoxia, hypercarbia, or both, to the extent that organ tissue perfusion is severely compromised. causes include chronic obstructive pulmonary disease, asthma, emphysema, acute respiratory distress syndrome, pneumonia, pulmonary edema, pneumothorax, and congestive heart failure. treatment requires intubation and mechanical ventilation until the time the lungs recover sufficient function.
Patient EducationClinical
Respiratory Failure
Respiratory failure is a condition in which your blood doesn't have enough oxygen or has too much carbon dioxide. Sometimes you can have both problems.
The full article covers:
- What is respiratory failure?
- What causes respiratory failure?
- What are the symptoms of respiratory failure?
- How is respiratory failure diagnosed?
- What are the treatments for respiratory failure?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert J96.90 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About J96.90Overview
Is J96.90 (Respiratory failure, unspecified) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does J96.90 group to?
When respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia is the principal diagnosis on an inpatient stay, it groups to MS-DRG 189, 929, 934, 928, with relative weights from 1.2107 to 7.6444 depending on complications. Higher weights mean higher Medicare reimbursement.
Is J96.90 a CC or MCC?
CMS lists J96.90 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 22 closely related codes in its exclusion list.
Can J96.90 be reported with J80?
Not as a rule. The Excludes1 note at J96, which applies to J96.90, lists "acute respiratory distress syndrome (J80)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What is the ICD-9 equivalent of J96.90?
Under the General Equivalence Mappings, respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia converts to ICD-9-CM 518.81 (acute respiratry failure). The mapping is approximate, so confirm the match fits the documentation.
What HCC is J96.90?
J96.90 (respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia) maps to CMS-HCC Category 213 (Cardio-Respiratory Failure and Shock), commonly written as HCC 213, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 84 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 J96.90 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, J96.90 adds a risk adjustment factor of about 0.370 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.258 to 0.662 depending on the payment segment). A more severe related category (HCC 211 and HCC 212) supersedes it when both are reported. See the full factor table on the HCC 213 category page.
