J86.9
BillablePyothorax without fistula
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 space around the lungs without an abnormal opening or tunnel connecting to the outside.
Coding Tips
- •Verify whether a fistula is present; if documented, use J86.0 instead
- •This code indicates infection/inflammation of the pleural space requiring drainage and antibiotics
Clinical Significance
Pyothorax without fistula (empyema) is a collection of infected fluid or pus in the pleural space, typically complicating pneumonia, thoracic surgery, or esophageal perforation. This condition requires chest tube drainage, prolonged antibiotic therapy, and may require surgical decortication. It represents significant morbidity and resource utilization beyond simple pleural effusion.
Documentation Requirements
- ✓Imaging confirming pleural fluid collection with characteristics of empyema (loculation, pleural thickening)
- ✓Pleural fluid analysis showing purulent fluid, positive cultures, or biochemical evidence of infection (low pH, low glucose, high LDH)
- ✓Documentation confirming no fistula is present (if fistula present, use J86.0)
- ✓Causative organism identification if available
- ✓Treatment plan including drainage and antibiotic regimen
Commonly Confused Codes
J86.0 — Pyothorax with fistula is used when an abnormal communication accompanies the empyemaJ90 — Pleural effusion not elsewhere classified is for non-infected effusionsJ91.0 — Malignant pleural effusion is cancer-related, not infectiousJ85.2 — Abscess of lung without pneumonia is infection in the lung parenchyma, not the pleural space