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ICD-10 Guide
ICD-10 CodesJ94.1

J94.1

Fibrothorax

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

Code Description

ICD-10 J94.1 is a billable code used to indicate a diagnosis of fibrothorax.

Key Diagnostic Point:

Fibrothorax, characterized by the accumulation of fibrous tissue in the pleural space, often results from chronic pleural inflammation or infection, such as tuberculosis or empyema. Clinically, patients may present with symptoms of dyspnea, chest pain, and reduced lung capacity due to the restrictive nature of the condition. The anatomy involved primarily includes the pleura, which is the membrane surrounding the lungs, and the lung parenchyma itself. Disease progression can lead to significant respiratory compromise, as the fibrous tissue can encase the lung, limiting its expansion during inhalation. Diagnostic considerations include imaging studies such as chest X-rays or CT scans, which can reveal pleural thickening and reduced lung volumes. Pulmonary function tests may also be utilized to assess the impact on lung function. Early diagnosis and management are crucial to prevent further complications, including respiratory failure.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical correlation.
  • Treatment complexity: May involve surgical intervention or management of underlying conditions.
  • Documentation requirements: Detailed clinical history and imaging findings are essential.
  • Coding specificity: Requires precise coding to differentiate from other pleural diseases.

Audit Risk Factors

  • Common coding errors: Misclassification with other pleural conditions.
  • Documentation gaps: Incomplete clinical notes or lack of imaging results.
  • Billing challenges: Potential denials if documentation does not support the diagnosis.

Specialty Focus

Medical Specialties

Pulmonology

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

Thoracic Surgery

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 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

Fibrothorax can significantly impact patient quality of life and respiratory function, leading to increased healthcare utilization. It is often associated with chronic conditions that may affect population health. Understanding the epidemiology of fibrothorax, particularly in populations with high rates of tuberculosis, is essential for developing effective public health strategies and improving patient outcomes.

ICD-9 vs ICD-10

Fibrothorax can significantly impact patient quality of life and respiratory function, leading to increased healthcare utilization. It is often associated with chronic conditions that may affect population health. Understanding the epidemiology of fibrothorax, particularly in populations with high rates of tuberculosis, is essential for developing effective public health strategies and improving patient outcomes.

Reimbursement & Billing Impact

Fibrothorax can significantly impact patient quality of life and respiratory function, leading to increased healthcare utilization. It is often associated with chronic conditions that may affect population health. Understanding the epidemiology of fibrothorax, particularly in populations with high rates of tuberculosis, is essential for developing effective public health strategies and improving patient outcomes.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for J00-J99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for J00-J99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by J94.1?

J94.1 specifically covers fibrothorax, which may arise from chronic pleural diseases, including post-infectious fibrosis, and is often seen in patients with a history of tuberculosis or other chronic pleural infections.

When should J94.1 be used instead of related codes?

J94.1 should be used when there is clear evidence of fibrous tissue formation in the pleura, differentiating it from other conditions like pleural effusion (J94.0) or pleurisy (J90).

What documentation supports J94.1?

Documentation should include imaging studies showing pleural thickening, clinical notes detailing symptoms, and any relevant history of pleural disease or treatment.