J95.03: Malfunction of tracheostomy stoma
J95.03 is a billable, specific ICD-10-CM code for malfunction of tracheostomy stoma. It is valid for submission on a claim.
Check J95.03 with the rest of the claim: free scrubberInclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Mechanical complication of tracheostomy stoma
- Obstruction of tracheostomy airway
- Tracheal stenosis due to tracheostomy
Excludes2 inherited from the categories above J95.03
Not part of this code, but both may be coded when both are present.
Risk adjustment
J95.03 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 211 Respirator Dependence/Tracheostomy Status/Complications0.879 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
J95.03 is named in 6 Medicare coverage policies: 6 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52492Tracheostomy Care Supplies - Policy Article
- A52519Suction Pumps - Policy Article
- A56658Billing and Coding: Cosmetic and Reconstructive Surgery
- A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
Alphabetic index entries that lead here
- Malfunction›tracheostomy
- Obstruction, obstructed, obstructive›tracheostomy airway
- Stenosis, stenotic›tracheostomy
- Stoma malfunction›tracheostomy
- Stricture›tracheostomy
- Complication›tracheostomy›malfunction
- Complication›tracheostomy›mechanical
- Complication›tracheostomy›obstruction
- Stricture›stoma›tracheostomy
- Tracheostomy›status›malfunctioning
Code history
Unchanged in every release from FY2024 to FY2027.