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v1.0.0
ICD-10 Guide
ICD-10 CodesR07.81

R07.81

Pleurodynia

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R07.81 is a billable code used to indicate a diagnosis of pleurodynia.

Key Diagnostic Point:

Pleurodynia refers to sharp, stabbing pain in the chest that is often exacerbated by breathing, coughing, or movement. This condition is typically associated with inflammation of the pleura, the membranes surrounding the lungs. Patients may describe the pain as localized to one side of the chest and may also experience accompanying symptoms such as shortness of breath or a dry cough. Common causes of pleurodynia include viral infections, particularly those caused by the Coxsackie virus, and can also be related to conditions such as pneumonia, pulmonary embolism, or pleuritis. Diagnosis is primarily clinical, supported by patient history and physical examination, with imaging studies like chest X-rays or CT scans used to rule out other conditions. Laboratory tests may be conducted to identify underlying infections or inflammatory processes. Accurate coding requires thorough documentation of the patient's symptoms, the clinical findings, and any diagnostic tests performed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in symptom presentation among patients
  • Need for differential diagnosis to rule out serious conditions
  • Potential overlap with other respiratory conditions
  • Documentation requirements for acute vs. chronic presentations

Audit Risk Factors

  • Inadequate documentation of the clinical findings
  • Failure to specify the underlying cause of pleurodynia
  • Misuse of related codes leading to upcoding or downcoding
  • Inconsistent coding between outpatient and inpatient settings

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed patient history, physical examination findings, and any relevant lab or imaging results.

Common Clinical Scenarios

Patients presenting with chest pain and respiratory symptoms, often requiring differentiation from cardiac issues.

Billing Considerations

Ensure documentation reflects the acute nature of symptoms and any relevant comorbidities.

Emergency Medicine

Documentation Requirements

Immediate assessment of chest pain, including vital signs, ECG findings, and initial lab results.

Common Clinical Scenarios

Acute presentations of pleurodynia in patients with possible life-threatening conditions.

Billing Considerations

Rapid identification of differential diagnoses is crucial; documentation must reflect urgency and thoroughness.

Coding Guidelines

Inclusion Criteria

Use R07.81 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when pleurodynia is the primary diagnosis or when it is a significant contributing factor to the patient's condition

Exclusion Criteria

Do NOT use R07.81 When
No specific exclusions found.

Related CPT Codes

99283CPT Code

Emergency department visit, moderate severity

Clinical Scenario

Used when a patient presents with pleurodynia and requires moderate complexity evaluation.

Documentation Requirements

Document the history, examination findings, and medical decision-making.

Specialty Considerations

Emergency medicine providers should ensure thorough documentation to support the level of service.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of pleurodynia, improving the accuracy of data collection and reimbursement processes. It emphasizes the need for detailed documentation to support the diagnosis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pleurodynia, improving the accuracy of data collection and reimbursement processes. It emphasizes the need for detailed documentation to support the diagnosis.

Reimbursement & Billing Impact

reimbursement processes. It emphasizes the need for detailed documentation to support the diagnosis.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the primary symptom of pleurodynia?

The primary symptom of pleurodynia is sharp, localized chest pain that worsens with breathing, coughing, or movement.

How is pleurodynia diagnosed?

Pleurodynia is diagnosed through clinical evaluation, including patient history, physical examination, and imaging studies to rule out other conditions.