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.
Code also
Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.
- the type of pneumonia
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.
Medicare coverage
J85.1 is named in 9 Medicare coverage policies — 9 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- 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
How J85.1 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to J85.1.
- Abscess›lung›with pneumonia
- Pneumonia›with›lung abscess
Related codes at this level
Codes that share J85. If J85.1 is not quite right, the correct code is usually one of these.
Questions about J85.1
- Is J85.1 a billable ICD-10-CM code?
- Yes. J85.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does J85.1 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Suppurative and necrotic conditions of the lower respiratory tract (J85-J86).