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ICD-10 Guide
ICD-10 CodesI31.3

I31.3

Non-billable

Pericardial effusion (noninflammatory)

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

Code Description

ICD-10 I31.3 is a used to indicate a diagnosis of pericardial effusion (noninflammatory).

Key Diagnostic Point:

Pericardial effusion (noninflammatory) refers to the accumulation of fluid in the pericardial cavity, which is the space between the heart and the pericardium, the fibrous sac surrounding the heart. This condition can arise from various causes, including heart failure, malignancies, renal failure, or as a consequence of certain medications. Clinically, patients may present with symptoms such as dyspnea, chest pain, or palpitations, although some may be asymptomatic. The anatomy involved includes the pericardium, which consists of two layers: the visceral and parietal pericardium. Disease progression can lead to cardiac tamponade, a life-threatening condition where the fluid accumulation exerts pressure on the heart, impairing its ability to pump effectively. Diagnostic considerations include echocardiography, which is the primary imaging modality for assessing pericardial effusion, as well as chest X-rays and CT scans for further evaluation. Laboratory tests may also be performed to identify underlying causes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical correlation to confirm diagnosis.
  • Treatment complexity: Management may involve observation, diuretics, or invasive procedures like pericardiocentesis.
  • Documentation requirements: Detailed documentation of symptoms, imaging findings, and treatment plans is essential.
  • Coding specificity: Accurate coding requires differentiation from inflammatory pericardial effusions and other cardiac conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of effusion type (inflammatory vs. noninflammatory).
  • Documentation gaps: Incomplete clinical history or lack of imaging results.
  • Billing challenges: Potential denials if documentation does not support the diagnosis or treatment provided.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Pericardial effusion has significant clinical implications, particularly if it progresses to cardiac tamponade, which can lead to increased morbidity and mortality. Understanding the epidemiology of this condition is crucial, as it can affect diverse populations, particularly those with underlying cardiovascular diseases. Quality measures related to timely diagnosis and management of pericardial effusion can improve patient outcomes and reduce healthcare utilization.

ICD-9 vs ICD-10

Pericardial effusion has significant clinical implications, particularly if it progresses to cardiac tamponade, which can lead to increased morbidity and mortality. Understanding the epidemiology of this condition is crucial, as it can affect diverse populations, particularly those with underlying cardiovascular diseases. Quality measures related to timely diagnosis and management of pericardial effusion can improve patient outcomes and reduce healthcare utilization.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of imaging studies and any procedures performed, such as pericardiocentesis. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for the services rendered. Coders should ensure that all relevant clinical information is included in the patient's medical record to support the billed services and avoid potential audits.

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 I31.3?

I31.3 covers noninflammatory pericardial effusion due to various etiologies such as heart failure, malignancies, and renal failure. It does not include effusions resulting from inflammatory conditions like pericarditis.

When should I31.3 be used instead of related codes?

I31.3 should be used when the pericardial effusion is confirmed to be noninflammatory, as indicated by clinical findings and imaging studies. If the effusion is associated with inflammatory conditions, codes like I31.0 or I31.1 should be utilized.

What documentation supports I31.3?

Documentation should include clinical symptoms, results from echocardiography or other imaging modalities confirming the presence of noninflammatory pericardial effusion, and any relevant laboratory tests that help identify underlying causes.