ICD-10 J91.0
Billable / Specific CCMalignant pleural effusion
About ICD-10-CM J91.0
ICD-10-CM code J91.0 represents Malignant pleural effusion. This is a billable/specific code in the Respiratory System chapter (block J91). The 2026 edition of ICD-10-CM J91.0 became effective on October 1, 2025.
Coding Tips for J91.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
J91.0 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.
Coding Notes
Code First
- underlying neoplasm (C00-D49)
Inpatient DRG Impact, CC
codes Malignant pleural effusion. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for J91.0
Local Coverage Determinations (LCDs) from CMS MACs that list J91.0 as a covered diagnosis.
Showing top 10 of 221 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing J91.0.
1 Cigna
5 Medicare
1 Aetna
CPT Codes Commonly Billed with J91.0
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 J91.0 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 |
|---|---|---|
| J91.0 | 51181 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To J91.0
Other codes in section J90-J94 (Other diseases of the pleura).
ICD-10 J91.0, Billing FAQ
Is ICD-10 code J91.0 billable? +
Yes, J91.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Is J91.0 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 J91.0 map to? +
Per CMS GEMs, J91.0 maps to ICD-9 codes: 51181. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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