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FY2027 ICD-10-CM reference

I31.31: Malignant pericardial effusion in diseases classified elsewhere

By the HCC Buddy Coding Team

The official ICD-10-CM descriptor is Malignant pericardial effusion in diseases classified elsewhere. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.

Billable code. Verified against the official FY2027 order file.

CMS-HCC V28

  • HCC 17: Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic · RAF 4.209, Community Non-Dual Aged (CNA)

Payment year 2027, 2026 dates of service. HCC from the CMS 2027 Initial ICD-10-CM Mappings; RAF from the CMS-HCC V28 relative factors. For 2027 dates of service, CMS has not yet published the payment year 2028 mappings.

CMS-HCC V24

Not used for payment year 2027 Medicare Advantage payment

ESRD

No category in the PY2026 CMS mapping; CMS 2027 initial file unchanged

PACE

Source verification pending

RxHCC

No category in the PY2026 CMS mapping; CMS 2027 initial file unchanged

HHS-HCC

  • HCC 135: Heart Infection/Inflammation, Except Rheumatic

RAF not applicable: HHS-HCC weights vary by metal level. Mapping: HHS-HCC 2026 benefit year.

FY2027 Tabular instructions

Instructions below include applicable chapter, section and parent-code notes. Each note identifies where it appears in the official source.

Excludes2

certain conditions originating in the perinatal period (P04-P96)

Source: I00-I99 (chapter, inherited).

Excludes2

certain infectious and parasitic diseases (A00-B99)

Source: I00-I99 (chapter, inherited).

Excludes2

complications of pregnancy, childbirth and the puerperium (O00-O9A)

Source: I00-I99 (chapter, inherited).

Excludes2

congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)

Source: I00-I99 (chapter, inherited).

Excludes2

endocrine, nutritional and metabolic diseases (E00-E88)

Source: I00-I99 (chapter, inherited).

Excludes2

injury, poisoning and certain other consequences of external causes (S00-T88)

Source: I00-I99 (chapter, inherited).

Excludes2

neoplasms (C00-D49)

Source: I00-I99 (chapter, inherited).

Excludes2

symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

Source: I00-I99 (chapter, inherited).

Excludes2

systemic connective tissue disorders (M30-M36)

Source: I00-I99 (chapter, inherited).

Excludes2

transient cerebral ischemic attacks and related syndromes (G45.-)

Source: I00-I99 (chapter, inherited).

Excludes1

diseases of pericardium specified as rheumatic (I09.2)

Source: I31 (category, inherited).

Excludes1

postcardiotomy syndrome (I97.0)

Source: I31 (category, inherited).

Excludes1

traumatic injury to pericardium (S26.-)

Source: I31 (category, inherited).

Excludes1

acute pericardial effusion (I30.9)

Source: I31.3 (self, inherited).

Code first

underlying neoplasm (C00-D49)

Source: I31.31 (self, direct).

Source: CMS FY2027 Tabular List and Alphabetic Index.

Open Tabular instructions and code details

Compare the FY2027 additions, removals and billable-status changes

What does I31.31 mean in FY2027?

The official ICD-10-CM descriptor is Malignant pericardial effusion in diseases classified elsewhere. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.

Is I31.31 billable in FY2027?

The FY2027 order file marks I31.31 as billable. Check the complete Tabular instructions and documentation before assigning it.

Does I31.31 map to an HCC?

In the CMS 2027 Initial ICD-10-CM Mappings (payment year 2027, 2026 dates of service), I31.31 maps to CMS-HCC V28 HCC 17 (Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic). For 2027 dates of service, CMS has not yet published the payment year 2028 mappings. Under the PY2026 CMS mapping; CMS 2027 initial file unchanged: no ESRD category; no RxHCC category. Coefficients for these models are pending verification for payment year 2027. HHS-HCC: HCC 135 under the HHS-HCC 2026 benefit year mapping (no RAF; HHS-HCC weights vary by metal level). CMS-HCC V24: not used for payment year 2027 Medicare Advantage payment (CMS CY 2027 Rate Announcement). The PACE mapping is still pending verification for FY2027.

Source: CMS FY2027 ICD-10-CM order file. Payment model: CMS CY 2027 Rate Announcement. Read the FY2027 Official Guidelines.

Review the FY2026 April edition