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v1.0.0
ICD-10 Guide
ICD-10 CodesI31.0

I31.0

Billable

Chronic adhesive pericarditis

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 I31.0 is a billable code used to indicate a diagnosis of chronic adhesive pericarditis.

Key Diagnostic Point:

Chronic adhesive pericarditis is a condition characterized by the thickening and fibrous scarring of the pericardium, the double-walled sac containing the heart. This condition often arises as a complication of previous pericarditis, particularly after infectious, inflammatory, or traumatic events. Clinically, patients may present with symptoms such as chest pain, dyspnea, and signs of heart failure due to impaired cardiac function. The anatomy involved includes the pericardium, which can become adherent to the myocardium, leading to restricted heart movement and compromised hemodynamics. Disease progression can vary; while some patients may remain stable, others may experience worsening symptoms and complications, including constrictive pericarditis. Diagnostic considerations include echocardiography, which can reveal pericardial thickening and effusion, and MRI or CT scans for more detailed imaging. A thorough clinical history and physical examination are essential for accurate diagnosis and management planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical correlation.
  • Treatment complexity: May involve medical management or surgical intervention.
  • Documentation requirements: Detailed clinical history and imaging results needed.
  • Coding specificity: Requires precise coding to differentiate from other pericardial diseases.

Audit Risk Factors

  • Common coding errors: Misclassification with acute pericarditis codes.
  • Documentation gaps: Incomplete clinical history or imaging reports.
  • Billing challenges: Denials due to lack of specificity in documentation.

Specialty Focus

Medical Specialties

Cardiology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Internal Medicine

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Chronic adhesive pericarditis can significantly impact patient quality of life and healthcare utilization. It may lead to increased hospitalizations and the need for surgical interventions in severe cases. Understanding the epidemiology of this condition is crucial, as it may be more prevalent in populations with a history of infectious diseases or prior cardiac surgeries. Quality measures should focus on timely diagnosis and effective management to reduce complications and improve patient outcomes.

ICD-9 vs ICD-10

Chronic adhesive pericarditis can significantly impact patient quality of life and healthcare utilization. It may lead to increased hospitalizations and the need for surgical interventions in severe cases. Understanding the epidemiology of this condition is crucial, as it may be more prevalent in populations with a history of infectious diseases or prior cardiac surgeries. Quality measures should focus on timely diagnosis and effective management to reduce complications and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly supported by clinical evidence and that any procedures performed are appropriately coded. Common denials may arise from insufficient documentation or misclassification of the condition. Best practices include maintaining thorough records of patient interactions and ensuring that all relevant clinical information is included in the billing submission.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by I31.0?

I31.0 specifically covers chronic adhesive pericarditis, which may develop after previous episodes of pericarditis or as a result of other underlying conditions such as tuberculosis or post-surgical changes.

When should I31.0 be used instead of related codes?

I31.0 should be used when the pericarditis is chronic and characterized by adhesions. It is distinct from acute pericarditis (I31.1) and other pericardial conditions that do not involve chronic changes.

What documentation supports I31.0?

Documentation should include a detailed clinical history, results from imaging studies (such as echocardiograms or MRIs), and any previous episodes of pericarditis or relevant medical history that may contribute to the diagnosis.