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v1.0.0
ICD-10 Guide
ICD-10 CodesJ94.2

J94.2

Hemothorax

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

Code Description

ICD-10 J94.2 is a billable code used to indicate a diagnosis of hemothorax.

Key Diagnostic Point:

Hemothorax refers to the accumulation of blood in the pleural cavity, which can occur due to trauma, surgery, or underlying medical conditions such as malignancy or coagulopathy. Clinically, patients may present with symptoms such as chest pain, dyspnea, tachycardia, and hypotension. The anatomy involved includes the pleura, lungs, and thoracic cavity, where the pleural space is normally filled with a small amount of pleural fluid. Disease progression can lead to respiratory distress and compromised lung function if not addressed promptly. Diagnostic considerations include imaging studies such as chest X-rays or CT scans, which can reveal the presence of fluid levels or blood in the pleural space. Thoracentesis may be performed for both diagnostic and therapeutic purposes, allowing for the analysis of pleural fluid and alleviation of respiratory symptoms. Early recognition and management are crucial to prevent complications such as infection or respiratory failure.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and possibly invasive procedures for confirmation.
  • Treatment complexity: May involve surgical intervention, drainage procedures, and management of underlying causes.
  • Documentation requirements: Detailed clinical notes and imaging results are essential for accurate coding.
  • Coding specificity: Requires precise documentation of the cause and nature of the hemothorax.

Audit Risk Factors

  • Common coding errors: Misclassification of hemothorax as pleural effusion.
  • Documentation gaps: Incomplete records regarding the cause or treatment of hemothorax.
  • Billing challenges: Potential denials if the documentation does not support the diagnosis or treatment provided.

Specialty Focus

Medical Specialties

Pulmonology

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

Emergency 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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Hemothorax can significantly impact patient outcomes, leading to increased morbidity and healthcare utilization. It is crucial for healthcare providers to recognize and manage this condition promptly to prevent complications such as respiratory failure. Epidemiologically, the incidence of hemothorax varies with trauma rates and underlying health conditions, making it an important consideration in population health management and quality measures.

ICD-9 vs ICD-10

Hemothorax can significantly impact patient outcomes, leading to increased morbidity and healthcare utilization. It is crucial for healthcare providers to recognize and manage this condition promptly to prevent complications such as respiratory failure. Epidemiologically, the incidence of hemothorax varies with trauma rates and underlying health conditions, making it an important consideration in population health management and quality measures.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of care, such as whether surgical intervention was necessary. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures. Best practices include ensuring that all clinical notes are complete and that the coding accurately reflects the services rendered, particularly in cases involving multiple interventions or complications.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for J00-J99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for J00-J99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by J94.2?

J94.2 specifically covers hemothorax resulting from trauma, surgical procedures, malignancies, or coagulopathy. It is important to document the underlying cause to ensure accurate coding.

When should J94.2 be used instead of related codes?

J94.2 should be used when there is clear evidence of blood accumulation in the pleural space, differentiating it from other pleural conditions such as effusion or empyema, which have distinct codes.

What documentation supports J94.2?

Documentation should include clinical findings, imaging results, the patient's history, and any procedures performed, such as thoracentesis or chest tube placement, to support the diagnosis of hemothorax.