J86.0

Billable

Pyothorax with fistula

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

An infection in the space around the lungs (pleural space) with pus that has created an abnormal opening or tunnel (fistula) allowing drainage.

Coding Tips

•Pyothorax with fistula indicates both infection and abnormal communication; document the fistula location and type
•Identify the source of the fistula (bronchopleural, esophagopleural, etc.) if documented for complete clinical picture

Clinical Significance

Pyothorax (empyema) with fistula represents infected pleural fluid with an abnormal communication (fistula) to the bronchial tree, chest wall, or other structures. This is a complex surgical condition requiring chest tube drainage, prolonged antibiotics, and often surgical decortication or repair of the fistula. The fistula component adds significant complexity and prevents standard non-operative management.

Documentation Requirements

✓Imaging confirming pleural fluid collection with empyema characteristics (loculation, enhanced pleural thickening)
✓Documentation of the fistula type and location (bronchopleural, pleurocutaneous, esophagopleural)
✓Culture results from pleural fluid identifying the causative organism
✓Treatment plan addressing both the empyema and fistula (drainage, antibiotics, surgical repair)
✓Underlying etiology documentation (post-surgical, infection, malignancy)

Code Also

, if applicable, disruption of internal operation (surgical) wound (T81.32-)

Commonly Confused Codes

J86.9 — Pyothorax without fistula is used when empyema is present but NO fistula is documented J85.1 — Abscess of lung with pneumonia is infection in the lung, not the pleural space J93.0 — Spontaneous tension pneumothorax may co-occur with bronchopleural fistula but is a separate finding J94.0 — Chylous effusion involves lymphatic fluid, not pus, in the pleural space

Code Hierarchy

└J86Pyothorax └J86.0Pyothorax with fistula

└J86.0Pyothorax with fistula