Respiratory failure, unspecified with hypercapnia

This code signifies a severe impairment of respiratory function where the lungs are unable to adequately oxygenate the blood or remove carbon dioxide, and the specific type of respiratory failure (e.g., acute, chronic) is not documented. A key feature is the presence of hypercapnia, indicating an abnormally high level of carbon dioxide in the arterial blood.

Assign this code when the medical record clearly states "respiratory failure with hypercapnia" but does not specify if it is acute or chronic. This is often seen in initial presentations where the chronicity is yet to be determined or in cases where the physician simply documents "hypercapnic respiratory failure, unspecified." Documentation must explicitly mention hypercapnia.

• Do not use this code if the documentation specifies acute, chronic, or acute on chronic respiratory failure; use the more specific code.
• Always look for documentation of the underlying cause of the respiratory failure, as this will likely be sequenced first.
• Ensure the medical record explicitly states "hypercapnia" or "hypercapnic" to support the use of this code, as opposed to respiratory failure with hypoxia.