ICD-10 J90
Billable / Specific CCPleural effusion, not elsewhere classified
About ICD-10-CM J90
ICD-10-CM code J90 represents Pleural effusion, not elsewhere classified. This is a billable/specific code in the Respiratory System chapter (block J90). The 2026 edition of ICD-10-CM J90 became effective on October 1, 2025.
Coding Tips for J90
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
J90 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under J90. Per CMS ICD-10-CM Tabular 2026.
- Encysted pleurisy
- Pleural effusion NOS
- Pleurisy with effusion (exudative) (serous)
Type 1 Excludes
Pure excludes, these codes can never be coded together with J90. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- chylous (pleural) effusion (J94.0)
- malignant pleural effusion (J91.0))
- pleurisy NOS (R09.1)
- tuberculous pleural effusion (A15.6)
Inpatient DRG Impact, CC
codes Pleural effusion, not elsewhere classified. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for J90
Local Coverage Determinations (LCDs) from CMS MACs that list J90 as a covered diagnosis.
Showing top 10 of 150 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing J90.
2 Cigna
5 Medicare
CPT Codes Commonly Billed with J90
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert J90 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| J90 | 5111 | 10000 |
| J90 | 51189 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To J90
Other codes in section J90-J94 (Other diseases of the pleura).
ICD-10 J90, Billing FAQ
Is ICD-10 code J90 billable? +
Yes, J90 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to J90? +
ICD-10 J90 includes: Encysted pleurisy; Pleural effusion NOS; Pleurisy with effusion (exudative) (serous).
What codes are Type 1 Excludes for J90? +
Type 1 Excludes (never code together with J90): chylous (pleural) effusion (J94.0); malignant pleural effusion (J91.0)); pleurisy NOS (R09.1)
Is J90 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does J90 map to? +
Per CMS GEMs, J90 maps to ICD-9 codes: 5111, 51189. Useful for legacy data review and historical claim analysis.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team