J91.0

J91.0: Malignant pleural effusion

Billable / specific codeICD-10-CM

J91.0 is a billable, specific ICD-10-CM code for malignant pleural effusion. It is valid for submission on a claim.

Check J91.0 with the rest of the claim: free scrubber

Code first

The underlying condition must be sequenced before this code.

underlying neoplasm (C00-D49)

Excludes2 inherited from the categories above J91.0

Not part of this code, but both may be coded when both are present.

Written on J91: Pleural effusion in conditions classified elsewhere

pleural effusion in heart failure (I50.-)
pleural effusion in systemic lupus erythematosus (M32.13)

Other codes that can never be billed with J91.0

Their own Excludes1 notes name this code, so the conflict is not listed above.

J90Pleural effusion, not elsewhere classified

Risk adjustment

J91.0 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 17 Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic4.209 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

J91.0 is named in 13 Medicare coverage policies: 13 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52986Billing and Coding: Biomarkers for Oncology
A53101Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® Update
A54188Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID®
A54386Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® Update

Alphabetic index entries that lead here

Effusion›malignant pleural
Effusion›pleura, pleurisy, pleuritic, pleuropericardial›malignant

Code history

Unchanged in every release from FY2024 to FY2027.

Other codes under J91

J91.8Pleural effusion in other conditions classified elsewhere