J85.3
BillableAbscess of mediastinum
HCC Category Mapping
V28HCC 283 — Lung Abscess/Gangrene of Lung
0.309V24HCC 115 — Pneumococcal Pneumonia, Empyema, Lung Abscess
0.339ESRDHCC 115 — Pneumococcal Pneumonia, Empyema, Lung Abscess
0.000What This Code Means
A collection of pus in the mediastinum, which is the space in the chest between the lungs containing the heart and major vessels.
Coding Tips
- •Mediastinal abscess is a serious condition; verify location is mediastinum and not lung parenchyma
- •Document the source of infection (esophageal perforation, post-surgical, etc.) if known
Clinical Significance
Abscess of mediastinum is a rare but extremely serious infection involving the space between the lungs containing the heart, great vessels, esophagus, and trachea. Common causes include esophageal perforation, descending necrotizing mediastinitis from odontogenic infections, and post-surgical complications. This diagnosis indicates life-threatening illness requiring emergent surgical intervention and carries high mortality.
Documentation Requirements
- ✓CT chest confirming fluid collection with rim enhancement in the mediastinal space
- ✓Identification of the source of infection (esophageal perforation, dental/pharyngeal infection, post-surgical, direct spread)
- ✓Culture and organism identification from drainage or surgical specimen
- ✓Documentation of surgical intervention (mediastinal drainage, debridement) or percutaneous drainage
- ✓Monitoring for complications including sepsis, great vessel erosion, and pericarditis
Commonly Confused Codes
J85.1/J85.2 — Abscess of lung is located in the lung parenchyma, not the mediastinal spaceJ86.0/J86.9 — Pyothorax involves the pleural space, not the mediastinumI30.1 — Infective pericarditis may co-occur with mediastinal abscess but is a separate diagnosisK22.3 — Perforation of esophagus may be the cause and should be coded separately if present