Is R09.1 a billable ICD-10-CM code?

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

Where does R09.1 sit in the tabular list?

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), in the block Symptoms and signs involving the circulatory and respiratory systems (R00-R09).

What cannot be coded together with R09.1?

R09.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above R09.1 (R09) and apply to it just the same.

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.

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

These are not written on R09.1, but they bind it: a note on a category applies to every code beneath it. Billing R09.1 with anything listed here is a denial.

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

These codes carry an Excludes1 note pointing at R09.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading R09.1 alone.

J90Pleural effusion, not elsewhere classified
J94Other pleural conditions

Risk adjustment

R09.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

R09.1 is named in 9 Medicare coverage policies — 9 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

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

How R09.1 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 R09.1.

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

Code history

R09.1 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share R09. If R09.1 is not quite right, the correct code is usually one of these.

Questions about R09.1

Is R09.1 a billable ICD-10-CM code?: Yes. R09.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does R09.1 sit in the tabular list?: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), in the block Symptoms and signs involving the circulatory and respiratory systems (R00-R09).
What cannot be coded together with R09.1?: R09.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above R09.1 (R09) and apply to it just the same.