Is J86.0 a billable ICD-10-CM code?

Yes. J86.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does J86.0 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).

What cannot be coded together with J86.0?

J86.0 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above J86.0 (J86) and apply to it just the same.

J86.0

J86.0 — Pyothorax with fistula

Billable / specific codeICD-10-CM

J86.0 is a billable, specific ICD-10-CM code for pyothorax with fistula. 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.

, if applicable, disruption of internal operation (surgical) wound (T81.32-)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Bronchocutaneous fistula
Bronchopleural fistula
Hepatopleural fistula
Mediastinal fistula
Pleural fistula
Thoracic fistula
Any condition classifiable to J86.9 with fistula

Excludes1 inherited from the categories above J86.0

These are not written on J86.0, but they bind it: a note on a category applies to every code beneath it. Billing J86.0 with anything listed here is a denial.

Written on J86 — Pyothorax

abscess of lung (J85.-)
pyothorax due to tuberculosis (A15.6)

Other codes that can never be billed with J86.0

These codes carry an Excludes1 note pointing at J86.0. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J86.0 alone.

J93Pneumothorax and air leak

Risk adjustment

J86.0 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

J86.0 is named in 8 Medicare coverage policies — 8 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A56389Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization
A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
A57063Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

How J86.0 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 J86.0.

Empyema›with fistula
Fistula›abdominothoracic
Fistula›bronchial
Fistula›bronchocutaneous, bronchomediastinal, bronchopleural, bronchopleuromediastinal(infective)
Fistula›bronchoesophageal
Fistula›bronchovisceral
Fistula›chest(wall)
Fistula›costal region
Fistula›diaphragm
Fistula›esophagobronchial
Fistula›esophagopleural-cutaneous
Fistula›esophagotracheal

Code history

J86.0 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share J86. If J86.0 is not quite right, the correct code is usually one of these.

J86.9Pyothorax without fistula

Questions about J86.0

Is J86.0 a billable ICD-10-CM code?: Yes. J86.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does J86.0 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).
What cannot be coded together with J86.0?: J86.0 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above J86.0 (J86) and apply to it just the same.