Pleural effusion in conditions classified elsewhere
In Other diseases of the pleura (J90-J94), chapter 10: Diseases of the Respiratory System
2 billable codes under J91: all are a CC; 1 map to HCC 17 (Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic).A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment. An HCC counts toward a Medicare Advantage patient's risk score.
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Instructional notes
Official coding guidelines
From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.
Covers COPD and asthma exacerbations, sequencing of acute respiratory failure, confirmed versus suspected identified influenza, ventilator associated pneumonia, and vaping-related disorders.
- Chronic Obstructive Pulmonary Disease [COPD] and Asthma (page 56)
- Acute Respiratory Failure (page 56)
- Influenza due to certain identified influenza viruses (page 57)
- Ventilator associated Pneumonia (page 57)
- Vaping-related disorders (page 58)
All codes under J91
J91 can't be used on a claim. Pick a billable code below; grey headings group them.
J91 MS-DRGs
As the principal diagnosis, the billable codes under J91 group to these 8 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.
- DRG 180 Respiratory Neoplasms with MCC (1 of 2 codes)
- DRG 181 Respiratory Neoplasms with CC (1 of 2 codes)
- DRG 182 Respiratory Neoplasms without CC/MCC (1 of 2 codes)
- DRG 186 Pleural Effusion with MCC (1 of 2 codes)
- DRG 187 Pleural Effusion with CC (1 of 2 codes)
- DRG 188 Pleural Effusion without CC/MCC (1 of 2 codes)
- DRG 791 Prematurity with Major Problems (1 of 2 codes)
- DRG 793 Full Term Neonate with Major Problems (1 of 2 codes)
About the condition
Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.
Pleural Disorders
Your pleura is a large, thin sheet of tissue that wraps around the outside of your lungs and lines the inside of your chest cavity. Between the layers of the pleura is a very thin space. Normally it's filled with a small amount of fluid. The fluid helps the two layers of the pleura glide smoothly past each other as your lungs breathe air in and out.
Read more about pleural disorders on MedlinePlusCode history
Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.