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J85.2
ICD-10-CM
Lung Abscess

Find comprehensive information on lung abscess diagnosis, including clinical documentation, medical coding (ICD-10 J85.1), and treatment. Learn about symptoms, causes, differential diagnosis, and diagnostic procedures for pulmonary abscess, including chest X-ray, CT scan, and percutaneous aspiration. This resource provides guidance for healthcare professionals on accurate lung abscess documentation and appropriate coding for optimal patient care and reimbursement. Explore best practices for managing and documenting lung abscesses in medical records.

Also known as

Pulmonary Abscess
Lung Cavity

Diagnosis Snapshot

Key Facts
  • Definition : A pus-filled cavity in the lung, usually caused by infection.
  • Clinical Signs : Cough (often with foul-smelling sputum), fever, chills, chest pain, shortness of breath.
  • Common Settings : Hospitalization, antibiotic therapy, drainage procedures (if needed).

Related ICD-10 Code Ranges

Complete code families applicable to AAPC J85.2 Coding
J85.0-J85.9

Abscess of lung and mediastinum

Covers various types of lung and mediastinal abscesses.

A48.0-A48.9

Bacterial infections of lung

Includes bacterial lung infections that can lead to abscess formation.

B20.0-B24.9

Human immunodeficiency virus

Immunocompromised states like HIV increase risk of lung abscesses.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the lung abscess related to aspiration?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Lung Abscess
Empyema
Severe pneumonia with lung tissue death. Code when imaging shows cavitation and rapid progression despite antibiotics.

Documentation Best Practices

Documentation Checklist
  • Document abscess size, location (lobe, segment), and number.
  • Describe appearance on imaging (CXR, CT): cavitation, air-fluid level.
  • Document symptoms: cough, fever, chest pain, sputum production (amount, color).
  • Note presence or absence of risk factors: aspiration, pneumonia, infection.
  • Document microbiology results (if available): culture, Gram stain, molecular tests.

Coding and Audit Risks

Common Risks
  • Unspecified Organism

    Coding for lung abscess lacks specific causative organism documentation, impacting DRG and quality reporting.

  • Sepsis Miscoding

    Incorrectly coding sepsis with lung abscess if not clinically validated, causing inaccurate severity reflection.

  • Documentation Clarity

    Vague documentation for lung abscess, lacking location or cause details, hinders accurate code assignment and audit defense.

Mitigation Tips

Best Practices
  • Document abscess location, size, and number for accurate ICD-10 coding (J85.2).
  • Thorough history and exam findings support CDI for lung abscess diagnosis.
  • Ensure proper specimen collection and lab tests for microbial analysis and compliance.
  • Image guided aspiration or drainage procedures require clear documentation for billing.
  • Monitor and document antibiotic therapy response for optimal patient care and compliance.

Clinical Decision Support

Checklist
  • 1. Confirm fever, cough, foul sputum (ICD-10 J85.1)
  • 2. Image (CXR/CT) showing cavitary lesion: Document size/location
  • 3. Rule out other lung pathologies: Pneumonia, malignancy (SNOMED CT 233634006)
  • 4. Assess risk factors: Aspiration, infection, immunosuppression
  • 5. Microbiology analysis if possible: Sputum/bronchial aspirate culture

Reimbursement and Quality Metrics

Impact Summary
  • Lung Abscess reimbursement hinges on accurate ICD-10 (J85.1) and DRG coding, impacting MS-DRG assignment and payment.
  • Coding quality directly affects Case Mix Index (CMI), impacting hospital reimbursement and quality reporting.
  • Thorough documentation of severity, etiology, and treatment is crucial for appropriate reimbursement and accurate APR-DRG classification.
  • Timely and accurate coding minimizes denials, improves revenue cycle, and positively impacts hospital financial performance.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code J85.0 for lung abscess
  • Document abscess location
  • Specify if primary or secondary
  • Consider ICD-10 combination codes
  • Document causative organism if known

Documentation Templates

Patient presents with symptoms suggestive of lung abscess, including persistent productive cough with foul-smelling sputum, fever, chills, night sweats, and weight loss.  Physical examination may reveal decreased breath sounds, dullness to percussion, and egophony over the affected lung area.  Differential diagnosis includes pneumonia, empyema, bronchiectasis, and malignancy.  Chest X-ray demonstrates a cavitary lesion with air-fluid level, consistent with lung abscess.  CT scan of the chest is recommended for further evaluation and to delineate the extent of the abscess.  Laboratory findings may include leukocytosis and elevated inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate.  Sputum culture and sensitivity are essential to identify the causative organism and guide antibiotic therapy.  Initial treatment consists of broad-spectrum antibiotics, typically including clindamycin, amoxicillin-clavulanate, or carbapenems.  Treatment duration typically ranges from several weeks to months, depending on clinical response and abscess resolution.  Percutaneous drainage or surgical intervention may be considered in cases of large abscesses, persistent symptoms, or complications such as hemoptysis or empyema.  Patient education regarding medication adherence, follow-up appointments, and potential complications is crucial.  ICD-10 code J85.1 for lung abscess is appropriate for this case, with additional codes for underlying conditions or complications as indicated.  CPT codes for diagnostic imaging, laboratory tests, and procedures performed will be documented separately.  Prognosis depends on factors such as the size and location of the abscess, the causative organism, and the patient's overall health status.