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2025 ICD-10-CM code I31.8

Other specified diseases of the pericardium, including conditions like epicardial plaques and focal pericardial adhesions.

Refer to the official ICD-10-CM coding guidelines for detailed instructions on selecting the most specific code possible.If uncertain, use the unspecified code (I31.9) instead of I31.8.

Medical necessity for coding I31.8 depends on the underlying clinical condition. The presence of symptoms, findings on imaging studies, and the physician's justification for the diagnosis are essential to establish medical necessity for billing and reimbursement purposes.

The clinical responsibility for coding I31.8 falls on the physician or qualified healthcare professional who diagnoses and manages the patient's condition.Accurate documentation of the specific findings and clinical course is essential for appropriate code assignment.

IMPORTANT:Consider using more specific codes from the I31 category (I31.0-I31.9) if the specific condition is known.For example, I31.0 for chronic adhesive pericarditis, I31.1 for chronic constrictive pericarditis, I31.2 for hemopericardium, I31.3 for noninflammatory pericardial effusion, I31.4 for cardiac tamponade, or I31.9 for unspecified disease of the pericardium.

In simple words: This code describes various problems with the sac surrounding the heart (pericardium) that don't fit into other, more specific categories.This could involve things like fatty deposits on the heart or scar tissue causing the sac to stick to the heart.

I31.8, Other specified diseases of the pericardium, encompasses various conditions affecting the pericardium that are not otherwise specified by more specific ICD-10-CM codes.Examples include epicardial plaques (fatty deposits on the outer layer of the heart) and focal pericardial adhesions (scar tissue causing the pericardium to stick to the heart).It is crucial to document the specific findings to support the selection of this code, as more specific codes exist for conditions such as pericarditis, pericardial effusion, and cardiac tamponade. This code excludes diseases of the pericardium specified as rheumatic (I09.2), postcardiotomy syndrome (I97.0), and traumatic injury to the pericardium (S26).

Example 1: A patient presents with chest pain and an echocardiogram reveals epicardial plaques.The physician documents these findings, and I31.8 is used as the diagnosis code., A patient undergoes cardiac surgery, and post-operative imaging reveals focal pericardial adhesions. The surgeon documents these adhesions, and I31.8 is used in conjunction with appropriate procedural codes., A patient presents with symptoms suggestive of pericardial disease, but further investigations (e.g., echocardiogram, pericardiocentesis) do not reveal a specific diagnosis.I31.8 is used as a placeholder until further diagnostic evaluation is conducted.

Complete and detailed medical record documentation is crucial. This must include a clear description of the clinical presentation, results of any diagnostic testing (e.g., echocardiography, CT scan, MRI), and physician's assessment.

** Always ensure the selected code aligns with the specific clinical findings and the overall medical record documentation.Inappropriate use of this code may lead to claim denials or other billing complications.

  • Payment Status: Active
  • Specialties:Cardiology
  • Place of Service:Inpatient Hospital, Outpatient Hospital, Office
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