J90 ICD-10-CM Code: Pleural effusion, not elsewhere classified
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Other diseases of the pleura (J90-J94)
J90
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePleural effusion, not elsewhere classified
Abnormal fluid accumulation around the lungs that is not caused by a specific documented condition.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Encysted pleurisy
- Pleural effusion NOS
- Pleurisy with effusion (exudative) (serous)
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for J90 in this effective period.
Related Child Codes
ICD-10-CM does not list child codes under J90 for this display context.
Includes
OfficialICD-10-CM does not list Includes notes for J90 in this effective period.
Excludes 1
Official- chylous (pleural) effusion (J94.0)
- malignant pleural effusion (J91.0))
- pleurisy NOS (R09.1)
- tuberculous pleural effusion (A15.6)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for J90 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for J90 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for J90 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is J90 an HCC code?
No. J90 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
J90 is the ICD-10-CM diagnosis code for pleural effusion, not elsewhere classified. Abnormal fluid accumulation around the lungs that is not caused by a specific documented condition. J90 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering other diseases of the pleura (j90-j94).
J90 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Use this code only when the underlying cause is not specified or classified elsewhere.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for J90 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the underlying cause is not specified or classified elsewhere
- •If a cause is documented (heart failure, malignancy, infection), use the more specific code for that condition