ICD-10 Coding for Loculated Pleural Effusion(J90, J91.0, J91.8)
Complete ICD-10-CM coding and documentation guide for Loculated Pleural Effusion. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Loculated Pleural Effusion
J90-J94Primary Range
Other diseases of pleura
This range includes codes for pleural effusion and related conditions, with J90 being the primary code for pleural effusion not elsewhere classified.
Tuberculosis
Includes codes for tuberculous pleural effusion, which is a differential diagnosis for loculated pleural effusion.
Malignant neoplasms of bronchus and lung
Relevant for malignant pleural effusion, which can present as loculated effusion.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| J90 | Pleural effusion, not elsewhere classified | Use when the cause of the pleural effusion is unknown or not linked to another condition. |
|
| J91.0 | Malignant pleural effusion | Use when effusion is confirmed to be due to malignancy. |
|
| J91.8 | Pleural effusion in conditions classified elsewhere | Use when effusion is secondary to another condition. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for loculated pleural effusion
Essential facts and insights about Loculated Pleural Effusion
Primary ICD-10-CM Codes for loculated pleural effusion
Decision Criteria
clinical Criteria
- No identifiable cause after thorough investigation
documentation Criteria
- Lack of documentation linking effusion to another condition
Applicable To
- Pleural effusion without specified cause
Clinical Validation Requirements
- Imaging showing pleural effusion without specific etiology
- No clinical evidence linking to another condition
Code-Specific Risks
- Risk of undercoding if underlying cause is not documented.
Coding Notes
- Ensure thorough investigation and documentation to rule out specific causes before using J90.
J91.0 - Malignant pleural effusion
Use when effusion is confirmed to be due to malignancy.
Applicable To
- Pleural effusion due to malignancy
Clinical Validation Requirements
- Cytology positive for cancer cells
- Imaging showing metastatic disease
Coding Notes
Always confirm malignancy through cytology or imaging.
J91.8 - Pleural effusion in conditions classified elsewhere
Use when effusion is secondary to another condition.
Applicable To
- Pleural effusion due to conditions like CHF, infection
Clinical Validation Requirements
- Linkage to another condition such as CHF or infection
Coding Notes
Ensure proper sequencing with the underlying condition.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Loculated Pleural Effusion to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code J90.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with coding standards., Financial: Potential for incorrect billing and reimbursement.
Mitigation Strategy
Ensure thorough clinical evaluation, Document all relevant findings
Impact
Reimbursement: May result in lower reimbursement if specificity is not captured., Compliance: Non-compliance with coding guidelines., Data Quality: Decreased accuracy in clinical data.
Mitigation Strategy
Use a more specific code like J91.0 or J91.8 when the cause is known.
Impact
Using J90 when a specific cause is documented elsewhere.
Mitigation Strategy
Regular audits and coder education on specificity requirements.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Loculated Pleural Effusion, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Loculated Pleural Effusion
Use these documentation templates to ensure complete and accurate documentation for Loculated Pleural Effusion. These templates include all required elements for proper coding and billing.
Loculated pleural effusion with unknown cause
Specialty: PulmonologyRequired Elements
- Imaging findings
- Fluid analysis
- Clinical symptoms
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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