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ICD-10-CM J95.859: Other complication of respirator [ventilator]

J95.859 is the billable ICD-10-CM code for other complication of respirator [ventilator], in category J95 (Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified) of the Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified section. As a principal diagnosis it groups to MS-DRG 205 Other Respiratory System Diagnoses with MCC, MS-DRG 206 Other Respiratory System Diagnoses without MCC (MDC 04 MDC 04: Diseases and Disorders of the Respiratory System); or MS-DRG 791 Prematurity with Major Problems, MS-DRG 793 Full Term Neonate with Major Problems (MDC 15 MDC 15: Newborns and Other Neonates with Conditions Originating in Perinatal Period). It maps to HCC 211 (Respirator Dependence/Tracheostomy Status/Complications) in CMS-HCC V28. As a secondary diagnosis it is a CC, excluded with 55 principal diagnoses. 1 LCD billing and coding article lists it as covered.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM code descriptions: FY2027 (effective October 1, 2026); IPPS Table 5 (MS-DRG weights): v44 FY2027 (final rule + CN3) (effective October 1, 2026); ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); Medicare Coverage Database billing and coding articles: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: FY2028 code files, effective October 1, 2027 for the ICD-10-CM code descriptions; FY2028 final rule (August 2027), effective October 1, 2027; an April 1 interim grouper update when CMS issues one for the IPPS Table 5 (MS-DRG weights); PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027) for the ICD-10-CM to HCC mapping; weekly, every Thursday for the Medicare Coverage Database billing and coding articles.

Code
J95.859
billable FY2027 ICD-10-CM code
Category
J95 Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified
Chapter
10: Diseases of the respiratory system (J00-J99)
CC/MCC (MS-DRG v44)
CC
CMS-HCC V28
HCC 211
POA reporting
Required

Tabular list notes for J95.859

The tabular list has no notes on J95.859 itself; the notes below apply from its parent headings.

Inherited from J95 (Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified)

Excludes2 (not part of this condition, may be coded together)
  • aspiration pneumonia (J69.-)
  • emphysema (subcutaneous) resulting from a procedure (T81.82)
  • hypostatic pneumonia (J18.2)
  • pulmonary manifestations due to radiation (J70.0-J70.1)

MS-DRG grouping when J95.859 is the principal diagnosis

MS-DRG v44 groups for J95.859 as principal diagnosis
MDCMS-DRGs
04 MDC 04: Diseases and Disorders of the Respiratory System205206
15 MDC 15: Newborns and Other Neonates with Conditions Originating in Perinatal Period791793

The final group also depends on procedures, secondary diagnoses and discharge status; the MS-DRG lookup for J95.859 shows the full grouping logic.

CC/MCC status and inpatient edits

As a secondary diagnosis, J95.859 is a CC under MS-DRG v44, unless the principal diagnosis is one of the 55 codes in its exclusion list. Check J95.859 against a principal diagnosis.

  • Present on admission: a POA indicator is required on inpatient claims.

CMS-HCC V28 risk adjustment

In the PY2027 mapping, J95.859 maps to HCC 211 (Respirator Dependence/Tracheostomy Status/Complications). The HCC lookup shows the RAF weight and the hierarchy.

LCD billing and coding articles that list J95.859

1 current Medicare billing and coding article lists J95.859 among the diagnoses that support medical necessity for the services they cover.

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Frequently asked questions

What does ICD-10-CM J95.859 mean?

J95.859 means other complication of respirator [ventilator]. It is one of 25 billable codes under J95, intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified.

Which MS-DRG does J95.859 group to?

As the principal diagnosis, J95.859 groups to MS-DRG 205 Other Respiratory System Diagnoses with MCC, MS-DRG 206 Other Respiratory System Diagnoses without MCC (MDC 04 MDC 04: Diseases and Disorders of the Respiratory System); or MS-DRG 791 Prematurity with Major Problems, MS-DRG 793 Full Term Neonate with Major Problems (MDC 15 MDC 15: Newborns and Other Neonates with Conditions Originating in Perinatal Period) under MS-DRG v44, before procedures and secondary diagnoses are applied.

Does J95.859 map to an HCC?

Yes: HCC 211, Respirator Dependence/Tracheostomy Status/Complications, in the PY2027 CMS-HCC V28 mapping.

Is J95.859 a CC or MCC?

J95.859 is a CC under MS-DRG v44; 55 principal diagnoses exclude it.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

The descriptor and notes are reproduced from the FY2027 ICD-10-CM files; MS-DRG, CC/MCC and HCC facts come from the CMS FY2027 and PY2027 tables. Code from the medical record and the ICD-10-CM Official Guidelines. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.