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ICD-10 Guide
ICD-10 CodesI31.39

I31.39

Billable

Other pericardial effusion (noninflammatory)

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

Code Description

ICD-10 I31.39 is a billable code used to indicate a diagnosis of other pericardial effusion (noninflammatory).

Key Diagnostic Point:

I31.39 refers to other pericardial effusion that is noninflammatory in nature. Pericardial effusion is the accumulation of fluid in the pericardial cavity, which can lead to increased pressure on the heart and impair its function. This condition may arise from various causes, including malignancies, renal failure, or hypothyroidism, and is often asymptomatic in its early stages. Clinically, patients may present with symptoms such as dyspnea, chest pain, or palpitations, particularly if the effusion is significant. The anatomy involved includes the pericardium, a double-walled sac surrounding the heart, which can become distended due to fluid accumulation. Disease progression can vary; while some patients may remain stable, others may develop cardiac tamponade, a life-threatening condition requiring urgent intervention. Diagnostic considerations include echocardiography, which is the primary imaging modality for assessing pericardial effusion, alongside clinical evaluation and history-taking to identify underlying causes. Laboratory tests may also be necessary to rule out inflammatory or infectious etiologies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical correlation to determine the cause and significance of the effusion.
  • Treatment complexity: Management may involve monitoring, diuretics, or pericardiocentesis depending on severity.
  • Documentation requirements: Detailed documentation of symptoms, imaging findings, and treatment plans is essential.
  • Coding specificity: Requires accurate coding to differentiate from other types of pericardial effusions.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of effusion or failure to document the underlying cause.
  • Documentation gaps: Incomplete clinical notes regarding the patient's symptoms or diagnostic findings.
  • Billing challenges: Potential denials related to insufficient documentation supporting the medical necessity of 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

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

The clinical significance of I31.39 lies in its potential to lead to serious complications such as cardiac tamponade if left untreated. Understanding the epidemiology of pericardial effusion is crucial, as it can affect population health, particularly in patients with underlying conditions such as cancer or renal disease. Quality measures may include monitoring the incidence of pericardial effusion and ensuring timely intervention to improve patient outcomes.

ICD-9 vs ICD-10

The clinical significance of I31.39 lies in its potential to lead to serious complications such as cardiac tamponade if left untreated. Understanding the epidemiology of pericardial effusion is crucial, as it can affect population health, particularly in patients with underlying conditions such as cancer or renal disease. Quality measures may include monitoring the incidence of pericardial effusion and ensuring timely intervention to improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly linked to the services provided. Common denials may arise from lack of documentation or failure to demonstrate the need for intervention. Coders should ensure that all relevant clinical information is included in the patient’s record to facilitate accurate billing and minimize audit risks.

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 I31.39?

I31.39 covers noninflammatory pericardial effusions that may arise from various conditions such as malignancies, renal failure, or hypothyroidism. It is important to differentiate these from inflammatory causes, which would be coded differently.

When should I31.39 be used instead of related codes?

I31.39 should be used when the pericardial effusion is confirmed to be noninflammatory and does not fit the criteria for other specific codes related to pericardial disease. Accurate diagnosis and documentation are crucial for appropriate code selection.

What documentation supports I31.39?

Documentation should include clinical findings, imaging results (such as echocardiograms), and any relevant laboratory tests that help establish the diagnosis of noninflammatory pericardial effusion. A clear treatment plan and follow-up notes are also essential.