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ICD-10 Guide
ICD-10 CodesI31.8

I31.8

Billable

Other specified diseases of pericardium

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

Code Description

ICD-10 I31.8 is a billable code used to indicate a diagnosis of other specified diseases of pericardium.

Key Diagnostic Point:

I31.8 refers to other specified diseases of the pericardium, which encompasses a range of conditions affecting the pericardium, the fibrous sac surrounding the heart. Clinical presentations may include pericarditis, pericardial effusion, and constrictive pericarditis, often resulting from infections, autoimmune disorders, or malignancies. The anatomy involved primarily includes the pericardial sac, which can become inflamed or filled with fluid, leading to compromised cardiac function. Disease progression can vary; acute conditions may resolve with treatment, while chronic issues can lead to significant morbidity, including heart failure. Diagnostic considerations include echocardiography, MRI, and CT scans to assess pericardial thickness, fluid accumulation, and overall cardiac function. Laboratory tests may also be necessary to identify underlying causes such as infections or autoimmune markers.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and laboratory tests to confirm diagnosis.
  • Treatment complexity: Management may involve medications, pericardiocentesis, or surgery.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • Coding specificity: Requires accurate differentiation from other pericardial conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of pericardial conditions.
  • Documentation gaps: Insufficient clinical details to support 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 ICD-10 Codes

Related CPT Codes

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 I31.8 lies in its potential to affect cardiac function and overall patient health. Pericardial diseases can lead to complications such as heart failure or cardiac tamponade, impacting population health. Quality measures may include monitoring for timely diagnosis and treatment of pericardial conditions, which can influence healthcare utilization patterns. Understanding the epidemiology of these diseases is crucial for effective management and prevention strategies.

ICD-9 vs ICD-10

The clinical significance of I31.8 lies in its potential to affect cardiac function and overall patient health. Pericardial diseases can lead to complications such as heart failure or cardiac tamponade, impacting population health. Quality measures may include monitoring for timely diagnosis and treatment of pericardial conditions, which can influence healthcare utilization patterns. Understanding the epidemiology of these diseases is crucial for effective management and prevention strategies.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis aligns with the services billed, particularly if procedures like pericardiocentesis are performed. Common denials may arise from insufficient documentation or lack of specificity in the diagnosis. Coders should ensure that all relevant clinical information is included in the medical record to support the use of I31.8 and related CPT codes.

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 I31.8?

I31.8 covers various pericardial diseases not classified elsewhere, including idiopathic pericarditis, post-myocardial infarction pericarditis, and pericardial effusion due to malignancy or infection.

When should I31.8 be used instead of related codes?

I31.8 should be used when the pericardial disease does not fit the definitions of other specific codes, such as acute or chronic pericarditis, and when the condition is documented as 'other specified'.

What documentation supports I31.8?

Documentation should include clinical findings, imaging results, laboratory tests, and a clear statement of the diagnosis, specifying that it is an 'other specified disease of the pericardium'.