J85.1

Billable

Abscess of lung with pneumonia

HCC Category Mapping

V28HCC 283 — Lung Abscess/Gangrene of Lung

0.309

V24HCC 115 — Pneumococcal Pneumonia, Empyema, Lung Abscess

0.339

ESRDHCC 115 — Pneumococcal Pneumonia, Empyema, Lung Abscess

0.000

What This Code Means

A collection of pus in the lung that has developed along with pneumonia (lung infection).

Coding Tips

•Requires documentation of both abscess AND pneumonia; code the pneumonia separately if not included in this code
•Identify the causative organism if documented to support antibiotic selection and treatment decisions

Clinical Significance

Abscess of lung with pneumonia indicates a localized collection of pus within the lung parenchyma occurring in the setting of pneumonia. This represents a serious complication of pulmonary infection requiring prolonged antibiotic therapy and potentially surgical drainage. The presence of both abscess and pneumonia indicates high-acuity illness with significant resource needs.

Documentation Requirements

✓Imaging (CT chest) confirming a cavitary lesion with air-fluid level consistent with lung abscess
✓Documentation of concurrent pneumonia (consolidation, clinical findings of infection)
✓Organism identification through sputum culture, blood culture, or bronchoscopic sampling
✓Treatment plan including duration of antibiotic therapy and need for percutaneous or surgical drainage
✓Follow-up imaging plan to confirm resolution

Code Also

the type of pneumonia

Commonly Confused Codes

J85.2 — Abscess of lung without pneumonia is used when abscess is present but pneumonia is NOT documented concurrently J85.0 — Gangrene and necrosis of lung implies tissue death beyond abscess formation J86.9 — Pyothorax without fistula is infection in the pleural space, not lung parenchyma J18.9 — Pneumonia unspecified does not capture the abscess complication and should not be used alone

Code Hierarchy

└J85Abscess of lung and mediastinum └J85.1Abscess of lung with pneumonia

└J85.1Abscess of lung with pneumonia