J86.0: Pyothorax with fistula
J86.0 is a billable, specific ICD-10-CM code for pyothorax with fistula. It is valid for submission on a claim.
Check J86.0 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.
- , 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
Other codes that can never be billed with J86.0
Their own Excludes1 notes name this code, so the conflict is not listed above.
- 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
J86.0 is named in 8 Medicare coverage policies: 8 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- 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
Alphabetic index entries that lead here
- 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
Unchanged in every release from FY2024 to FY2027.