2025 ICD-10-CM code I31.3
(Valid) Effective Date: N/A Revision Date: N/A Diseases of the circulatory system - Other diseases of pericardium (I31) Chapter 9: Diseases of the circulatory system (I00-I99) Feed
Pericardial effusion (noninflammatory).This code excludes acute pericardial effusion (I30.9).
Medical necessity for treatment depends on the size of the effusion, the patient's symptoms, and the underlying cause.Significant effusions causing symptoms such as shortness of breath or chest pain may require intervention to prevent cardiac complications. Treatment for smaller, asymptomatic effusions may not be medically necessary and could be managed with observation.The documentation should clearly link the effusion to the symptoms and justify the chosen treatment.
The clinician is responsible for diagnosing the pericardial effusion through physical examination, imaging studies (such as echocardiography or chest X-ray), and possibly other tests to determine the underlying cause. They are also responsible for managing the condition, which may include monitoring, medication, or procedures to remove the fluid.
In simple words: Fluid has accumulated around your heart in the pericardium (the sac surrounding the heart).This condition is noninflammatory, meaning it's not caused by infection or inflammation.
Pericardial effusion (noninflammatory)
Example 1: A patient presents with shortness of breath and chest discomfort.An echocardiogram reveals a significant accumulation of fluid around the heart, consistent with a noninflammatory pericardial effusion.The patient's medical history does not indicate any recent infection or inflammatory conditions., A patient undergoing cancer treatment develops a pericardial effusion as a side effect of chemotherapy.The effusion is determined to be noninflammatory.Code I31.3 would be used, and the underlying neoplasm should also be coded., Following a heart surgery, a patient develops a pericardial effusion that is not associated with infection or inflammation. This would be coded as a noninflammatory pericardial effusion (I31.3), distinct from postcardiotomy syndrome (I97.0).
Documentation should include details of the diagnostic workup (physical exam, imaging studies like echocardiogram or chest X-ray), the presence and extent of the effusion, the absence of inflammatory markers, and any associated underlying conditions.If a specific cause is identified, it should also be documented.
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