J86.9: Pyothorax without fistula
J86.9 is a billable, specific ICD-10-CM code for pyothorax without fistula. It is valid for submission on a claim.
Check J86.9 with the rest of the claim: free scrubberInclusion 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
Other codes that can never be billed with J86.9
Their own Excludes1 notes name this code, so the conflict is not listed above.
- J93Pneumothorax and air leak
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. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
J86.9 is named in 6 Medicare coverage policies: 6 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- 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
Alphabetic index entries that lead here
- Empyema(acute) (chest) (double) (pleura) (supradiaphragmatic) (thorax)
- Pyopneumothorax(infective)
- Pyothorax
- Abscess›chest
- Abscess›peripleuritic
- Abscess›pleura
- Abscess›thorax
- Pleurisy›staphylococcal
Code history
Unchanged in every release from FY2024 to FY2027.