J96.12: Chronic respiratory failure with hypercapnia
J96.12 is a billable, specific ICD-10-CM code for chronic respiratory failure with hypercapnia. It is valid for submission on a claim.
Check J96.12 with the rest of the claim: free scrubberInclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Chronic respiratory acidosis
Excludes1 inherited from the categories above J96.12
A category’s note binds every code beneath it.
Written on J96: Respiratory failure, not elsewhere classified
Other codes that can never be billed with J96.12
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
J96.12 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
J96.12 is named in 8 Medicare coverage policies: 8 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
- A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
- A56758Billing and Coding: Non-Invasive Vascular Studies
- A56784Billing and Coding: Pulmonary Stress Testing
Alphabetic index entries that lead here
- Acidosis›respiratory›chronic
- Failure, failed›respiration, respiratory›chronic›with›hypercapnia
- Failure, failed›respiration, respiratory›chronic›with›hypercarbia
Code history
Unchanged in every release from FY2024 to FY2027.