2025 ICD-10-CM code I31.31
(Active) Effective Date: N/A Revision Date: N/A Diseases of the pericardium - Other forms of heart disease (I30-I5A) Diseases of the circulatory system (I00-I99) Feed
Malignant pericardial effusion in diseases classified elsewhere. Code first the underlying neoplasm (C00-D49).
Medical necessity for services related to I31.31 is established by the presence of the malignant pericardial effusion and the need for intervention to manage symptoms or prevent complications like cardiac tamponade.The medical record should clearly document the signs, symptoms, and clinical findings supporting the diagnosis and the rationale for any procedures performed.
Clinicians diagnosing and treating the underlying neoplasm and managing the resulting pericardial effusion are responsible for accurately documenting and coding this condition. This often involves collaboration between oncologists, cardiologists, and other specialists depending on the primary cancer site.
In simple words: Fluid buildup around the heart caused by cancer spreading from another part of the body.
Malignant pericardial effusion occurring as a secondary manifestation of a primary neoplasm. The underlying neoplasm should be coded first.
Example 1: A patient with lung cancer (C34.90) develops a pericardial effusion due to metastatic spread. I31.31 would be coded secondary to C34.90., A patient with breast cancer (C50.919) presents with shortness of breath and chest pain. Imaging reveals a malignant pericardial effusion. C50.919 is coded first, followed by I31.31., A patient receiving chemotherapy for lymphoma (C85.90) develops a large pericardial effusion requiring drainage. C85.90 is coded first, and I31.31 is coded as a secondary diagnosis.
Documentation should clearly establish the presence of pericardial effusion and its malignant nature, typically through imaging studies (e.g., echocardiogram, CT scan) or pericardiocentesis with cytology. The documentation must also link the effusion to a primary malignancy, as this code is always secondary to the underlying neoplasm.The type of malignancy needs to be specified.
- Payment Status: Active
- Specialties:Cardiology, Oncology, Internal Medicine, Thoracic Surgery (depending on the primary site of the malignancy)
- Place of Service:Inpatient Hospital, Outpatient Hospital, Physician's Office