ICD Code J96.91

ICD code J96.91 is used to classify a medical condition where a patient experiences respiratory failure that is not specified in detail, accompanied by hypoxia, which means there is a deficiency in the amount of oxygen reaching the tissues. This code is utilized in healthcare documentation to indicate that the patient has a serious respiratory condition requiring medical attention, but the exact cause or type of respiratory failure is not detailed beyond the presence of low oxygen levels.

1. Acute or Chronic Respiratory Distress: The patient exhibits signs of respiratory distress, which may include rapid breathing, shortness of breath, or difficulty breathing, without a clear acute or chronic classification.

2. Hypoxia: Clinical evidence or diagnostic tests indicate low levels of oxygen in the blood, characterized by symptoms such as cyanosis, confusion, or restlessness.

3. Arterial Blood Gas (ABG) Analysis: ABG results show decreased partial pressure of oxygen (PaO2) and/or increased partial pressure of carbon dioxide (PaCO2), confirming hypoxia.

4. Oxygen Saturation Levels: Pulse oximetry readings consistently show oxygen saturation levels below normal thresholds, typically below 90%.

5. Exclusion of Other Causes: Other potential causes of hypoxia, such as anemia or carbon monoxide poisoning, have been ruled out through appropriate diagnostic testing.

6. Clinical Judgment: The healthcare provider uses clinical judgment to determine that the respiratory failure is unspecified, meaning it does not clearly fit into acute or chronic categories, but is accompanied by hypoxia.

7. Documentation: The patient's medical records clearly document the presence of respiratory failure with hypoxia, without specifying the acute or chronic nature of the condition.

For the ICD code J96.91, which pertains to respiratory failure, unspecified with hypoxia, the relevant CPT codes that may be applicable for treatment include:

1. 94002 - Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day.

2. 94003 - Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, each subsequent day.

3. 94004 - Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; nursing facility, per day.

4. 94660 - Continuous positive airway pressure ventilation (CPAP), initiation and management.

5. 94662 - Continuous negative pressure ventilation (CNP), initiation and management.

6. 31500 - Intubation, endotracheal, emergency procedure.

7. 99291 - Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes.

8. 99292 - Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes.

These CPT codes are typically used in the context of managing and treating conditions associated with respiratory failure and may vary based on the specific clinical scenario and treatment plan. Always consult with coding professionals or resources to ensure accurate coding and billing practices.

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments for CPT codes associated with ICD code J96.91. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.