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.
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
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
Related codes at this level
Codes that share J86. If J86.0 is not quite right, the correct code is usually one of these.
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).