2025 ICD-10-CM code J91.8
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the respiratory system - Pleural effusion in conditions classified elsewhere Diseases of the respiratory system (J00-J99) Feed
Pleural effusion in other conditions classified elsewhere. Code first the underlying disease.
Medical necessity is established by the presence of a clinically significant pleural effusion that impacts the patient's respiratory function or necessitates medical intervention (such as thoracentesis or other treatment). The underlying condition that causes the pleural effusion must also be documented and medically necessary.
The clinical responsibility lies with the physician managing the underlying condition leading to the pleural effusion.Thoracentesis (if performed) would fall under the responsibility of the physician or other qualified healthcare professional performing the procedure.
In simple words: This code describes fluid buildup around the lungs caused by a medical condition that's already been diagnosed.The doctor will have already given a code for the main medical condition; this code is added only if there's also fluid around the lungs.
J91.8, Pleural effusion in other conditions classified elsewhere, indicates the presence of fluid accumulation in the pleural space due to causes other than those specifically listed in other ICD-10-CM codes.This code is used when the pleural effusion is secondary to a condition already coded.It is crucial to code the underlying disease first, followed by J91.8 as an additional code. Examples of underlying conditions include filariasis, influenza, and various other specified conditions.The absence of a specified cause for the pleural effusion would necessitate a query to the physician for clarification.Chronic pleural effusions with known causes and without symptoms typically do not require a thoracentesis or pleural fluid analysis; therefore, this code might not be appropriate in such cases.
Example 1: A patient with known filariasis presents with shortness of breath and is found to have a pleural effusion on chest X-ray.The primary diagnosis is filariasis (B74.-), with J91.8 added as an additional code for the pleural effusion., A patient hospitalized for influenza (J09.X2, J10.1, J11.1) develops a pleural effusion requiring thoracentesis.Both influenza and J91.8 are coded., A patient with a known lung cancer (C34.-) develops a large pleural effusion.The primary code is for the lung cancer, with J91.8 added for the pleural effusion.
Thorough documentation is necessary, including the underlying diagnosis, clinical findings (such as chest X-ray results showing pleural effusion), and any procedures performed (e.g., thoracentesis, pleural fluid analysis).Physician notes explaining the relationship between the underlying condition and the pleural effusion are crucial for accurate coding.
** Use of this code requires careful consideration of the underlying cause of the pleural effusion.Always refer to the latest ICD-10-CM coding guidelines for the most up-to-date information.
- Payment Status: Active
- Specialties:Pulmonology, Oncology, Cardiology, Infectious Disease
- Place of Service:Inpatient Hospital, Outpatient Hospital, Physician's Office