J91.0 — Malignant pleural effusion
J91.0 is a billable, specific ICD-10-CM code for malignant pleural effusion. It is valid for submission on a claim.
Other codes that can never be billed with J91.0
These codes carry an Excludes1 note pointing at J91.0. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J91.0 alone.
- 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.
Medicare coverage
J91.0 is named in 13 Medicare coverage policies — 13 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- 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
How J91.0 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to J91.0.
- Effusion›malignant pleural
- Effusion›pleura, pleurisy, pleuritic, pleuropericardial›malignant
Related codes at this level
Codes that share J91. If J91.0 is not quite right, the correct code is usually one of these.
Questions about J91.0
- Is J91.0 a billable ICD-10-CM code?
- Yes. J91.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does J91.0 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Other diseases of the pleura (J90-J94).