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ICD-10 Guide
ICD-10 CodesI31.31

I31.31

Billable

Malignant pericardial effusion in diseases classified elsewhere

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

Code Description

ICD-10 I31.31 is a billable code used to indicate a diagnosis of malignant pericardial effusion in diseases classified elsewhere.

Key Diagnostic Point:

Malignant pericardial effusion refers to the accumulation of fluid in the pericardial space due to malignancies, often associated with cancers such as lung, breast, or hematological malignancies. Clinically, patients may present with symptoms such as dyspnea, chest pain, or signs of cardiac tamponade, which can lead to hemodynamic instability. The pericardium, a double-walled sac surrounding the heart, can become inflamed or compromised due to the underlying malignancy, leading to fluid accumulation. Disease progression can vary; some patients may experience rapid accumulation of fluid, while others may have a more gradual onset. Diagnostic considerations include echocardiography, which is the primary imaging modality used to assess pericardial effusion, and may be complemented by CT or MRI for further evaluation. Additionally, pericardiocentesis may be performed both for diagnostic and therapeutic purposes, allowing for fluid analysis and symptom relief. Accurate diagnosis and management are crucial, as malignant pericardial effusion can significantly impact the patient's prognosis and quality of life.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive evaluation and differentiation from other causes of pericardial effusion.
  • Treatment complexity: Management may involve oncological treatment, pericardiocentesis, or surgical intervention.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to reflect the underlying malignancy and associated complications.

Audit Risk Factors

  • Common coding errors: Misclassification of the effusion type or failure to document the malignancy.
  • Documentation gaps: Incomplete clinical notes regarding the underlying condition or treatment.
  • Billing challenges: Potential denials due to lack of supporting documentation for the malignancy or associated procedures.

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

Oncology

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

Malignant pericardial effusion significantly affects patient quality of life and can lead to increased healthcare utilization due to hospitalizations and procedures. Understanding its epidemiology is crucial, as it often indicates advanced disease and poor prognosis. Quality measures may focus on timely diagnosis and management to improve outcomes for affected patients, highlighting the importance of effective coding and documentation in capturing the burden of this condition.

ICD-9 vs ICD-10

Malignant pericardial effusion significantly affects patient quality of life and can lead to increased healthcare utilization due to hospitalizations and procedures. Understanding its epidemiology is crucial, as it often indicates advanced disease and poor prognosis. Quality measures may focus on timely diagnosis and management to improve outcomes for affected patients, highlighting the importance of effective coding and documentation in capturing the burden of this condition.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear clinical justification for procedures like pericardiocentesis. Common denials may arise from insufficient documentation linking the effusion to the malignancy or failure to provide adequate clinical notes. Best practices include ensuring that all relevant clinical findings, imaging results, and treatment plans are thoroughly documented to support the medical necessity of the services rendered.

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 I31.31?

I31.31 covers malignant pericardial effusion resulting from various malignancies, including lung cancer, breast cancer, and hematological malignancies such as lymphoma or leukemia. It is essential to document the underlying malignancy to support the use of this code.

When should I31.31 be used instead of related codes?

I31.31 should be used when the pericardial effusion is specifically due to a malignancy. If the effusion is due to non-malignant causes, other codes such as I31.0 should be utilized. Accurate differentiation is crucial for proper coding.

What documentation supports I31.31?

Documentation should include the diagnosis of the underlying malignancy, clinical findings related to the pericardial effusion, results from imaging studies, and any procedures performed such as pericardiocentesis. Detailed notes on the patient's symptoms and treatment plan are also essential.