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ICD-10-CM J96.01: Acute respiratory failure with hypoxia

J96.01 is the billable ICD-10-CM code for acute respiratory failure with hypoxia, in category J96 (Respiratory failure, not elsewhere classified) of the Other diseases of the respiratory system section. As a principal diagnosis it groups to MS-DRG 189 Pulmonary Edema and Respiratory Failure (MDC 04 MDC 04: Diseases and Disorders of the Respiratory System); or MS-DRG 928 Full Thickness Burn with Skin Graft or Inhalation Injury with CC/MCC, MS-DRG 929 Full Thickness Burn with Skin Graft or Inhalation Injury without CC/MCC, MS-DRG 934 Full Thickness Burn without Skin Graft or Inhalation Injury (MDC 22 MDC 22: Burns). It maps to HCC 213 (Cardio-Respiratory Failure and Shock) in CMS-HCC V28. As a secondary diagnosis it is an MCC, excluded with 22 principal diagnoses. 14 LCD billing and coding articles list 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
J96.01
billable FY2027 ICD-10-CM code
Category
J96 Respiratory failure, not elsewhere classified
Chapter
10: Diseases of the respiratory system (J00-J99)
CC/MCC (MS-DRG v44)
MCC
CMS-HCC V28
HCC 213
POA reporting
Required

Tabular list notes for J96.01

The tabular list has no notes on J96.01 itself; the notes below apply from its parent headings.

Inherited from J96 (Respiratory failure, not elsewhere classified)

Excludes1 (never coded together)
  • acute respiratory distress syndrome (J80)
  • cardiorespiratory failure (R09.2)
  • newborn respiratory distress syndrome (P22.0)
  • postprocedural respiratory failure (J95.82-)
  • respiratory arrest (R09.2)
  • respiratory arrest of newborn (P28.81)
  • respiratory failure of newborn (P28.5)

MS-DRG grouping when J96.01 is the principal diagnosis

MS-DRG v44 groups for J96.01 as principal diagnosis
MDCMS-DRGs
04 MDC 04: Diseases and Disorders of the Respiratory System189
22 MDC 22: Burns928929934

The final group also depends on procedures, secondary diagnoses and discharge status; the MS-DRG lookup for J96.01 shows the full grouping logic.

CC/MCC status and inpatient edits

As a secondary diagnosis, J96.01 is an MCC under MS-DRG v44, unless the principal diagnosis is one of the 22 codes in its exclusion list. Check J96.01 against a principal diagnosis.

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

CMS-HCC V28 risk adjustment

In the PY2027 mapping, J96.01 maps to HCC 213 (Cardio-Respiratory Failure and Shock). The HCC lookup shows the RAF weight and the hierarchy.

LCD billing and coding articles that list J96.01

14 current Medicare billing and coding articles list J96.01 among the diagnoses that support medical necessity for the services they cover.

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Frequently asked questions

What does ICD-10-CM J96.01 mean?

J96.01 means acute respiratory failure with hypoxia. It is one of 12 billable codes under J96, respiratory failure, not elsewhere classified.

Which MS-DRG does J96.01 group to?

As the principal diagnosis, J96.01 groups to MS-DRG 189 Pulmonary Edema and Respiratory Failure (MDC 04 MDC 04: Diseases and Disorders of the Respiratory System); or MS-DRG 928 Full Thickness Burn with Skin Graft or Inhalation Injury with CC/MCC, MS-DRG 929 Full Thickness Burn with Skin Graft or Inhalation Injury without CC/MCC, MS-DRG 934 Full Thickness Burn without Skin Graft or Inhalation Injury (MDC 22 MDC 22: Burns) under MS-DRG v44, before procedures and secondary diagnoses are applied.

Does J96.01 map to an HCC?

Yes: HCC 213, Cardio-Respiratory Failure and Shock, in the PY2027 CMS-HCC V28 mapping.

Is J96.01 a CC or MCC?

J96.01 is an MCC under MS-DRG v44; 22 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.