J95.04 Tracheo-esophageal fistula following tracheostomy

Billable ICD-10-CM code, FY2026. Acts as a Complication or Comorbidity (CC) as a secondary diagnosis.

Applies from J95 Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified

Excludes2 (not included here)

• aspiration pneumonia (J69.-)
• emphysema (subcutaneous) resulting from a procedure (T81.82)
• hypostatic pneumonia (J18.2)
• pulmonary manifestations due to radiation (J70.0-J70.1)

Risk adjustment (HCC)

• CMS-HCC V28: HCC 211 — Respirator Dependence/Tracheostomy Status/Complications
• CMS-HCC V22: HCC 82 — Respirator Dependence/Tracheostomy Status
• ESRD V24: HCC 82

MS-DRG index

Defines the logic of DRG(s) 011-013 in MDC PRE.

Approximate ICD-9-CM (GEMs)

• 519.09 Other tracheostomy complications (approximate)

Code annotations containing back-references to J95.04

Back-references to J95.0

• Type 2 Excludes: T81 Complications of procedures, not elsewhere classified ("ostomy complications (J95.0-, K94.-, N99.5-)")
• Type 1 Excludes: Z43 Encounter for attention to artificial openings ("complications of external stoma (J95.0-, K94.-, N99.5-)")
• Type 1 Excludes: Z93 Artificial opening status ("complications of external stoma (J95.0-, K94.-, N99.5-)")

Back-references to J95

• Type 2 Excludes: T81 Complications of procedures, not elsewhere classified ("intraoperative and postprocedural complications of specific body system (D78.-, E36.-, E89.-, G97.3-, G97.4, H59.3-, H59.-, H95.2-, H95.3, I97.4-, I97.5, J95, K91.-, L76.-, M96.-, N99.-)")

Diagnosis Index entries for J95.04

• Complication (s) (from) (of) › tracheostomy › tracheo-esophageal fistula
• Fistula (cutaneous) › tracheoesophageal › following tracheostomy

Nearby codes

• J95.0 Tracheostomy complications
• J95.00 Unspecified tracheostomy complication
• J95.01 Hemorrhage from tracheostomy stoma
• J95.02 Infection of tracheostomy stoma
• J95.03 Malfunction of tracheostomy stoma
• J95.04 Tracheo-esophageal fistula following tracheostomy (this code)
• J95.09 Other tracheostomy complication
• J95.1 Acute pulmonary insufficiency following thoracic surgery
• J95.2 Acute pulmonary insufficiency following nonthoracic surgery
• J95.3 Chronic pulmonary insufficiency following surgery
• J95.4 Chemical pneumonitis due to anesthesia