FY2027
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Excludes1 pair

J90 vs J91.0

J90 and J91.0 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.

The official note, declared on J90
malignant pleural effusion (J91.0))
J90

Pleural effusion, not elsewhere classified

BillableUnspecified
Chapter 10
Diseases of the respiratory system
Section
J90-J94
Use when the record says
  • Encysted pleurisy
  • Pleural effusion NOS
  • Pleurisy with effusion (exudative) (serous)
Indexed under
  • Effusion › pleura, pleurisy, pleuritic, pleuropericardial
  • Pleurisy › pneumococcal
  • Pleurisy › streptococcal
  • Pleurisy › with › effusion
J91.0

Malignant pleural effusion

Billable
Chapter 10
Diseases of the respiratory system
Section
J90-J94
Indexed under
  • Effusion › malignant pleural
  • Effusion › pleura, pleurisy, pleuritic, pleuropericardial › malignant

Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027