2025 ICD-10-CM code J91.0
Malignant pleural effusion. This code should be used in conjunction with a code for the primary neoplasm.
Medical necessity for procedures related to malignant pleural effusion is established by the presence of symptoms (e.g., shortness of breath, chest pain) and the need for diagnostic or therapeutic intervention (e.g., thoracentesis, pleurodesis). The underlying malignancy should also be documented.
The physician is responsible for diagnosing the malignant pleural effusion and the underlying malignancy, typically involving physical examination, imaging studies (chest X-ray, CT scan), and analysis of pleural fluid.
In simple words: Fluid buildup around the lungs due to cancer.
Malignant pleural effusion is the accumulation of fluid in the pleural space, surrounding the lungs, due to the presence of a malignant tumor. It's essential to code the underlying neoplasm first, followed by J91.0.
Example 1: A patient with known lung cancer presents with shortness of breath and chest pain. A chest X-ray reveals pleural effusion, and subsequent fluid analysis confirms malignancy. The physician documents malignant pleural effusion secondary to lung cancer., A patient with breast cancer develops a pleural effusion. Diagnostic tests confirm the presence of malignant cells in the pleural fluid. The physician diagnoses malignant pleural effusion due to metastatic breast cancer., During a routine follow-up visit, a patient with mesothelioma is found to have a new pleural effusion. The effusion is determined to be malignant. The physician documents malignant pleural effusion in the context of mesothelioma.
Documentation should clearly state the presence of a malignant pleural effusion and the underlying neoplasm. Supporting evidence may include imaging reports, pleural fluid analysis, and clinical findings.
** J91.0 is a manifestation code and cannot be sequenced as the principal diagnosis. ICD-10-CM guidelines instruct to "code first" the underlying neoplasm.Commonly associated procedures include thoracentesis (32555), pleural catheter insertion (32550), and complete blood count (85025).
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- Specialties:Pulmonology, Oncology, Internal Medicine, Thoracic Surgery
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