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ICD-10 Guide
ICD-10 CodesI31

I31

Non-billable

Other diseases of pericardium

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

Code Description

ICD-10 I31 is a used to indicate a diagnosis of other diseases of pericardium.

Key Diagnostic Point:

I31 encompasses various diseases of the pericardium, which is the fibrous sac surrounding the heart. Conditions under this code include pericarditis, pericardial effusion, and constrictive pericarditis. Clinical presentations may vary from mild chest pain and discomfort to severe symptoms such as dyspnea and hypotension, depending on the underlying cause and severity of the disease. The anatomy involved primarily includes the pericardium, which can become inflamed or filled with fluid, leading to compromised cardiac function. Disease progression can lead to chronic conditions, such as constrictive pericarditis, where the pericardium becomes thickened and fibrotic, restricting the heart's ability to fill properly. Diagnostic considerations include imaging studies like echocardiography, which can reveal pericardial effusion, and MRI or CT scans for detailed assessment. Laboratory tests may also be necessary to identify underlying infections or autoimmune conditions contributing to pericardial disease.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and laboratory tests for accurate diagnosis.
  • Treatment complexity: Management may involve medications, drainage procedures, or surgery.
  • Documentation requirements: Detailed clinical notes are essential to support diagnosis and treatment.
  • Coding specificity: Requires careful differentiation from other cardiovascular codes.

Audit Risk Factors

  • Common coding errors: Misclassification of pericardial conditions.
  • Documentation gaps: Incomplete clinical notes leading to insufficient support for the diagnosis.
  • Billing challenges: Potential denials due to lack of specificity in coding.

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 CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

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

The clinical significance of I31 lies in its potential to affect heart function and overall cardiovascular health. Population health impact includes the prevalence of pericardial diseases, which can lead to increased healthcare utilization and costs. Quality measures may focus on timely diagnosis and effective management of pericardial conditions, emphasizing the importance of early intervention to prevent complications.

ICD-9 vs ICD-10

The clinical significance of I31 lies in its potential to affect heart function and overall cardiovascular health. Population health impact includes the prevalence of pericardial diseases, which can lead to increased healthcare utilization and costs. Quality measures may focus on timely diagnosis and effective management of pericardial conditions, emphasizing the importance of early intervention to prevent complications.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly linked to the services rendered. Common denials may arise from insufficient documentation or coding errors. Best practices include maintaining detailed clinical notes, ensuring accurate coding, and regularly reviewing payer guidelines to stay compliant with billing requirements.

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?

I31 covers a range of pericardial diseases, including acute and chronic pericarditis, pericardial effusion, and constrictive pericarditis. Each condition has specific diagnostic criteria, often requiring imaging studies and clinical evaluation.

When should I31 be used instead of related codes?

I31 should be used when the diagnosis specifically involves diseases of the pericardium that do not fall under acute pericarditis (I30) or pericarditis due to systemic disease (I32). Accurate differentiation is crucial for proper coding.

What documentation supports I31?

Documentation should include clinical findings, imaging results, and treatment plans. Specific notes on symptoms, diagnostic tests performed, and any underlying conditions contributing to pericardial disease are essential.