J90 ICD-10-CM Code: Pleural effusion, not elsewhere classified
J90 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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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
HistoricalHistorical
Not used for CY2026 payment
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
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from J00-J99
- certain infectious and parasitic diseases (A00-B99)Inherited from J00-J99
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from J00-J99
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from J00-J99
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from J00-J99
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from J00-J99
- neoplasms (C00-D49)Inherited from J00-J99
- smoke inhalation (T59.81-)Inherited from J00-J99
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from J00-J99
Related Codes
No related codes are included in this display for J90. Check the Code Book for the complete code path.
Includes
OfficialNo Includes notes are included in this display for J90. Check the code and parent instructions in the Code Book.
Excludes 1
Official- chylous (pleural) effusion (J94.0)
- malignant pleural effusion (J91.0))
- pleurisy NOS (R09.1)
- tuberculous pleural effusion (A15.6)
Code First
OfficialNo Code First sequencing instructions are included in this display for J90. Check the code and parent instructions in the Code Book.
Use Additional
Official- code, where applicable, to identify:Inherited from J00-J99
- exposure to environmental tobacco smoke (Z77.22)Inherited from J00-J99
- exposure to tobacco smoke in the perinatal period (P96.81)Inherited from J00-J99
- history of tobacco dependence (Z87.891)Inherited from J00-J99
- occupational exposure to environmental tobacco smoke (Z57.31)Inherited from J00-J99
- tobacco dependence (F17.-)Inherited from J00-J99
- tobacco use (Z72.0)Inherited from J00-J99
Code Also
OfficialNo Code Also instructions are included in this display for J90. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is J90 an HCC code?
No. J90 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.
- Code
- J90
- Description
- Pleural effusion, not elsewhere classified
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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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 no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.
Use this code only when the underlying cause is not specified or classified elsewhere.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, 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