Is J96.1 a billable ICD-10-CM code?

No. J96.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does J96.1 sit in the tabular list?

Diseases of the respiratory system (J00-J99), in the block Other diseases of the respiratory system (J96-J99).

What cannot be coded together with J96.1?

J96.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above J96.1 (J96) and apply to it just the same.

J96.1

J96.1 — Chronic respiratory failure

Non-billable headerICD-10-CM

J96.1 is a non-billable header ICD-10-CM code for chronic respiratory failure. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 inherited from the categories above J96.1

These are not written on J96.1, but they bind it: a note on a category applies to every code beneath it. Billing J96.1 with anything listed here is a denial.

Written on J96 — Respiratory failure, not elsewhere classified

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)

Other codes that can never be billed with J96.1

These codes carry an Excludes1 note pointing at J96.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J96.1 alone.

R06Abnormalities of breathing
R09Other symptoms and signs involving the circulatory and respiratory system
R09.2Respiratory arrest

Risk adjustment

J96.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code history

J96.1 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead J96.1

3 child codes. Green means billable.

Related codes at this level

Codes that share J96. If J96.1 is not quite right, the correct code is usually one of these.

Questions about J96.1

Is J96.1 a billable ICD-10-CM code?: No. J96.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does J96.1 sit in the tabular list?: Diseases of the respiratory system (J00-J99), in the block Other diseases of the respiratory system (J96-J99).
What cannot be coded together with J96.1?: J96.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above J96.1 (J96) and apply to it just the same.