J90 vs J94.0
J90 and J94.0 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
The official note, declared on J90
chylous (pleural) effusion (J94.0)
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 (acute) (adhesive) (chronic) (costal) (diaphragmatic) (double) (dry) (fibrinous) (fibrous) (interlobar) (latent) (plastic) (primary) (residual) (sicca) (sterile) (subacute) (unresolved)
- Pleurisy › streptococcal (acute) (adhesive) (chronic) (costal) (diaphragmatic) (double) (dry) (fibrinous) (fibrous) (interlobar) (latent) (plastic) (primary) (residual) (sicca) (sterile) (subacute) (unresolved)
- Pleurisy › with › effusion (acute) (adhesive) (chronic) (costal) (diaphragmatic) (double) (dry) (fibrinous) (fibrous) (interlobar) (latent) (plastic) (primary) (residual) (sicca) (sterile) (subacute) (unresolved)
J94.0
Chylous effusion
Billable
- Chapter 10
- Diseases of the respiratory system
- Section
- J90-J94
Use when the record says
- Chyliform effusion
Indexed under
- Chylothorax (nonfilarial)
- Effusion › chylous, chyliform
- Effusion › pleura, pleurisy, pleuritic, pleuropericardial › chylous, chyliform
- Pleurisy › with › effusion › chylous, chyliform (acute) (adhesive) (chronic) (costal) (diaphragmatic) (double) (dry) (fibrinous) (fibrous) (interlobar) (latent) (plastic) (primary) (residual) (sicca) (sterile) (subacute) (unresolved)
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