Is J86.9 a billable ICD-10-CM code?

Yes. J86.9 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does J86.9 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).

J86.9

J86.9 — Pyothorax without fistula

Billable / specific codeICD-10-CM

J86.9 is a billable, specific ICD-10-CM code for pyothorax without fistula. It is valid for submission on a claim.

Inclusion terms

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

Abscess of pleura
Abscess of thorax
Empyema (chest) (lung) (pleura)
Fibrinopurulent pleurisy
Purulent pleurisy
Pyopneumothorax
Septic pleurisy
Seropurulent pleurisy
Suppurative pleurisy

Risk adjustment

J86.9 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

J86.9 is named in 6 Medicare coverage policies — 6 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 J86.9 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 J86.9.

Empyema(acute) (chest) (double) (pleura) (supradiaphragmatic) (thorax)
Pyopneumothorax(infective)
Pyothorax
Abscess›chest
Abscess›peripleuritic
Abscess›pleura
Abscess›thorax
Pleurisy›staphylococcal

Related codes at this level

Codes that share J86. If J86.9 is not quite right, the correct code is usually one of these.

J86.0Pyothorax with fistula

Questions about J86.9

Is J86.9 a billable ICD-10-CM code?: Yes. J86.9 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does J86.9 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).