J96.11 — Chronic respiratory failure with hypoxia
J96.11 is a billable, specific ICD-10-CM code for chronic respiratory failure with hypoxia. It is valid for submission on a claim.
Excludes1 inherited from the categories above J96.11
These are not written on J96.11, but they bind it: a note on a category applies to every code beneath it. Billing J96.11 with anything listed here is a denial.
Written on J96 — Respiratory failure, not elsewhere classified
Other codes that can never be billed with J96.11
These codes carry an Excludes1 note pointing at J96.11. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J96.11 alone.
Risk adjustment
J96.11 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 213 Cardio-Respiratory Failure and Shock0.370 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.
Medicare coverage
J96.11 is named in 10 Medicare coverage policies — 9 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52514Oxygen and Oxygen Equipment - Policy Articlenot covered
- A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
- A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
- A56758Billing and Coding: Non-Invasive Vascular Studies
How J96.11 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to J96.11.
- Failure, failed›respiration, respiratory›chronic›with›hypoxia
Code history
J96.11 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share J96.1. If J96.11 is not quite right, the correct code is usually one of these.
Questions about J96.11
- Is J96.11 a billable ICD-10-CM code?
- Yes. J96.11 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does J96.11 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 J96.11?
- J96.11 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 J96.11 (J96) and apply to it just the same.