R09.1

R09.1: Pleurisy

Billable / specific codeICD-10-CM

R09.1 is a billable, specific ICD-10-CM code for pleurisy. It is valid for submission on a claim.

Check R09.1 with the rest of the claim: free scrubber

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

pleurisy with effusion (J90)

Excludes1 inherited from the categories above R09.1

A category’s note binds every code beneath it.

Written on R09: Other symptoms and signs involving the circulatory and respiratory system

acute respiratory distress syndrome (J80)
respiratory arrest of newborn (P28.81)
respiratory distress syndrome of newborn (P22.0)
respiratory failure (J96.-)
respiratory failure of newborn (P28.5)

Other codes that can never be billed with R09.1

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

J90Pleural effusion, not elsewhere classified
J94Other pleural conditions

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

R09.1 is named in 9 Medicare coverage policies: 9 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
A57205Billing and Coding: Oximetry Services
A57224Billing and Coding: Respiratory Care

Alphabetic index entries that lead here

Pleurisy(acute) (adhesive) (chronic) (costal) (diaphragmatic) (double) (dry) (fibrinous) (fibrous) (interlobar) (latent) (plastic) (primary) (residual) (sicca) (sterile) (subacute) (unresolved)

Code history

Unchanged in every release from FY2024 to FY2027.