J85.1: Abscess of lung with pneumonia
J85.1 is a billable, specific ICD-10-CM code for abscess of lung with pneumonia. It is valid for submission on a claim.
Check J85.1 with the rest of the claim: free scrubberCode also
Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.
- the type of pneumonia
Other codes that can never be billed with J85.1
Their own Excludes1 notes name this code, so the conflict is not listed above.
- J86Pyothorax
Risk adjustment
J85.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 283 Empyema, Lung Abscess0.204 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
J85.1 is named in 9 Medicare coverage policies: 9 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
- A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
- A57205Billing and Coding: Oximetry Services
- A57224Billing and Coding: Respiratory Care
Alphabetic index entries that lead here
- Abscess›lung›with pneumonia
- Pneumonia›with›lung abscess
Code history
Unchanged in every release from FY2024 to FY2027.