2021 ICD-10-CM ACUTE RESPIRATORY FAILURE GUIDELINES
Acute Respiratory Failure
1) Acute respiratory failure as principal diagnosis
A code from subcategory J96.0, Acute respiratory failure, or subcategory J96.2, Acute and
chronic respiratory failure, may be assigned as a principal diagnosis when it is the
condition established after study to be chiefly responsible for occasioning the admission
to the hospital, and the selection is supported by the Alphabetic Index and Tabular List.
However, chapter-specific coding guidelines (such as obstetrics, poisoning, HIV, newborn)
that provide sequencing direction take precedence.
When considering acute respiratory failure as principal diagnosis, be sure to think of the
acronym SOAP. With the SOAP acronym situations, respiratory failure will “never” be
the principal diagnosis.
S – sepsis
O – obstetrics
A – AIDS/HIV disease
P - poisoning
2) Acute respiratory failure as secondary diagnosis
Respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or
if it is present on admission, but does not meet the definition of principal diagnosis.
3) Sequencing of acute respiratory failure and another acute condition
When a patient is admitted with respiratory failure and another acute condition, (e.g.,
myocardial infarction, cerebrovascular accident, aspiration pneumonia), the principal
diagnosis will not be the same in every situation. This applies whether the other acute
condition is a respiratory or nonrespiratory condition. Selection of the principal diagnosis
will be dependent on the circumstances of admission. If both the respiratory failure and
the other acute condition are equally responsible for occasioning the admission to the
hospital, and there are no chapter-specific sequencing rules, the guideline regarding two
or more diagnoses that equally meet the definition for principal diagnosis (Section II, C.)
may be applied in these situations.
If the documentation is not clear as to whether acute respiratory failure and another
condition are equally responsible for occasioning the admission, query the provider for
clarification.
2021 ICD-10-CM SELECTION OF THE PRINCIPAL DIAGNOSIS GUIDELINES
The circumstances of inpatient admission always govern the selection of principal
diagnosis. The principal diagnosis is defined in the Uniform Hospital Discharge Data Set
(UHDDS) as “that condition established after study to be chiefly responsible for
occasioning the admission of the patient to the hospital for care.”
B. Two or more interrelated conditions, each potentially meeting the definition for
principal diagnosis.
When there are two or more interrelated conditions (such as diseases in the same ICD10-CM chapter or manifestations characteristically associated with a certain disease)
potentially meeting the definition of principal diagnosis, either condition may be
sequenced first, unless the circumstances of the admission, the therapy provided, the
Tabular List, or the Alphabetic Index indicate otherwise.
C. Two or more diagnoses that equally meet the definition for principal diagnosis
In the unusual instance when two or more diagnoses equally meet the criteria for
principal diagnosis as determined by the circumstances of admission, diagnostic workup
and/or therapy provided, and the Alphabetic Index, Tabular List, or another coding
guidelines does not provide sequencing direction, any one of the diagnoses may be
sequenced first.
Acute Respiratory Failure
1) Acute respiratory failure as principal diagnosis
A code from subcategory J96.0, Acute respiratory failure, or subcategory J96.2, Acute and
chronic respiratory failure, may be assigned as a principal diagnosis when it is the
condition established after study to be chiefly responsible for occasioning the admission
to the hospital, and the selection is supported by the Alphabetic Index and Tabular List.
However, chapter-specific coding guidelines (such as obstetrics, poisoning, HIV, newborn)
that provide sequencing direction take precedence.
When considering acute respiratory failure as principal diagnosis, be sure to think of the
acronym SOAP. With the SOAP acronym situations, respiratory failure will “never” be
the principal diagnosis.
S – sepsis
O – obstetrics
A – AIDS/HIV disease
P - poisoning
2) Acute respiratory failure as secondary diagnosis
Respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or
if it is present on admission, but does not meet the definition of principal diagnosis.
3) Sequencing of acute respiratory failure and another acute condition
When a patient is admitted with respiratory failure and another acute condition, (e.g.,
myocardial infarction, cerebrovascular accident, aspiration pneumonia), the principal
diagnosis will not be the same in every situation. This applies whether the other acute
condition is a respiratory or nonrespiratory condition. Selection of the principal diagnosis
will be dependent on the circumstances of admission. If both the respiratory failure and
the other acute condition are equally responsible for occasioning the admission to the
hospital, and there are no chapter-specific sequencing rules, the guideline regarding two
or more diagnoses that equally meet the definition for principal diagnosis (Section II, C.)
may be applied in these situations.
If the documentation is not clear as to whether acute respiratory failure and another
condition are equally responsible for occasioning the admission, query the provider for
clarification.
2021 ICD-10-CM SELECTION OF THE PRINCIPAL DIAGNOSIS GUIDELINES
The circumstances of inpatient admission always govern the selection of principal
diagnosis. The principal diagnosis is defined in the Uniform Hospital Discharge Data Set
(UHDDS) as “that condition established after study to be chiefly responsible for
occasioning the admission of the patient to the hospital for care.”
B. Two or more interrelated conditions, each potentially meeting the definition for
principal diagnosis.
When there are two or more interrelated conditions (such as diseases in the same ICD10-CM chapter or manifestations characteristically associated with a certain disease)
potentially meeting the definition of principal diagnosis, either condition may be
sequenced first, unless the circumstances of the admission, the therapy provided, the
Tabular List, or the Alphabetic Index indicate otherwise.
C. Two or more diagnoses that equally meet the definition for principal diagnosis
In the unusual instance when two or more diagnoses equally meet the criteria for
principal diagnosis as determined by the circumstances of admission, diagnostic workup
and/or therapy provided, and the Alphabetic Index, Tabular List, or another coding
guidelines does not provide sequencing direction, any one of the diagnoses may be
sequenced first.