HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Suppurative and necrotic conditions of the lower respiratory tract (J85-J86)
J85.2
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAbscess of lung without pneumonia
A collection of pus in the lung without an accompanying pneumonia infection.
Buddy Insight
Abscess of lung without pneumonia describes a localized pus collection within the lung parenchyma in the absence of concurrent pneumonia.
CMS-HCC V28
MappedHCC 283
RAF 0.309
CMS-HCC V24
MappedHCC 115
RAF 0.339
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 115
RAF 0.0
RXHCC
00
RAF 0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
Official- Abscess of lung NOS
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for J85.2 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for J85.2 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for J85.2 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for J85.2 in this effective period.
Use Additional
Official- code (B95-B97) to identify infectious agent.
Code Also
OfficialICD-10-CM does not list Code Also instructions for J85.2 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is J85.2 an HCC code?
Yes. J85.2 maps to Lung Abscess/Gangrene of Lung under the CMS-HCC V28 risk adjustment model (and Pneumococcal Pneumonia, Empyema, Lung Abscess under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for J85.2
For J85.2to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed J85.2 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
J85.2 is the ICD-10-CM diagnosis code for abscess of lung without pneumonia. A collection of pus in the lung without an accompanying pneumonia infection. J85.2 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering suppurative and necrotic conditions of the lower respiratory tract (j85-j86).
Under the CMS-HCC V28 risk adjustment model, J85.2 maps to Lung Abscess/Gangrene of Lung (HCC 283) with a community, non-dual, aged base RAF weight of 0.309. Under the older CMS-HCC V24 model, J85.2 maps to Pneumococcal Pneumonia, Empyema, Lung Abscess (HCC 115) with a community, non-dual, aged base RAF weight of 0.339. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Distinguish from J85.1 by confirming absence of pneumonia in the documentation. Because J85.2 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for J85.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Distinguish from J85.1 by confirming absence of pneumonia in the documentation
- •Document the causative organism if identified through culture or imaging to guide treatment
Clinical Significance
Abscess of lung without pneumonia describes a localized pus collection within the lung parenchyma in the absence of concurrent pneumonia. This can occur from hematogenous seeding, aspiration, or as a late sequela of resolved pneumonia. It requires prolonged antibiotic therapy and possibly drainage, representing significant clinical complexity and resource utilization.
Documentation Requirements
- ✓Imaging (CT chest) confirming a cavitary lesion with air-fluid level consistent with lung abscess
- ✓Documentation confirming absence of concurrent pneumonia (clear lung fields surrounding the abscess)
- ✓Organism identification if available through culture or sampling
- ✓Treatment plan including antibiotic regimen and drainage considerations
- ✓Risk factor assessment (aspiration risk, immunocompromised status, dental disease)
Commonly Confused Codes
- •J85.1 — Abscess of lung with pneumonia should be used when concurrent pneumonia IS documented
- •J85.0 — Gangrene and necrosis of lung implies tissue death, a more severe finding than abscess alone
- •J85.3 — Abscess of mediastinum is infection in the mediastinal space, not the lung parenchyma
- •A06.5 — Amebic lung abscess has a specific code when the organism is Entamoeba histolytica