Empyema ICD-10-CM Codes

What ICD-10 Codes are Used for Empyema 

Empyema is a serious medical condition characterized by the accumulation of pus in a body cavity, most commonly in the pleural space surrounding the lungs. Accurate medical coding is essential for proper reimbursement and tracking of this condition. Here are the commonly used Empyema ICD-10 codes, along with clinical descriptions for each code:

1. J86.0 - Pyothorax with Fistula: This code is used to describe empyema (pyothorax) with the presence of a fistula, which is an abnormal connection between the pleural cavity and another organ or structure. The presence of a fistula can complicate the management and treatment of empyema.
2. J86.9 - Pyothorax without Fistula: This code is utilized when empyema (pyothorax) is present in the pleural cavity without forming a fistula. The absence of a fistula simplifies the treatment approach compared to cases with fistula involvement.
3. J86.8 - Other Pyothorax: This code is used when the empyema (pyothorax) case does not fit the criteria of J86.0 or J86.9. It includes cases with rare presentations or specific complications not covered by the other codes.
4. J86.1 - Pyothorax with Effusion: This code is applied when there is evidence of pleural effusion (fluid accumulation) and empyema (pyothorax). The presence of effusion may lead to distinct clinical features and management considerations.
5. J18.2 - Pneumonia, Unspecified Organism, with Empyema: This code is used when empyema is a complication of pneumonia, and the causative organism is unspecified. It is common for empyema to develop as a severe pneumonia complication, especially in delayed or inadequate treatment cases.
6. J15.6 - Pneumonia due to other Gram-negative Bacteria, with Empyema: This code is assigned when Empyema develops as a complication of pneumonia caused by specific Gram-negative bacteria other than the ones mentioned in other codes. Gram-negative bacteria are associated with severe infections and may increase the risk of empyema development.
7. J85.1 - Abscess of Lung with Pneumonia: This code is used when there is a lung abscess along with pneumonia, and the abscess has become infected with pyogenic bacteria, leading to empyema. It highlights the severity of the condition and the presence of an abscess.
8. J85.0 - Gangrene and Necrosis of Lung with Pneumonia: This code is assigned when there is gangrene or necrosis of the lung in conjunction with pneumonia, which has progressed to empyema. This is a life-threatening situation requiring urgent medical intervention.

These are some of the commonly used ICD-10 codes for Empyema. Proper coding helps healthcare providers, insurers, and researchers document and accurately manage patients with this condition. To learn more about these codes, consider watching this video:

Which Empyema ICD codes are Billable 

Below are the commonly used Empyema ICD-10 codes, along with their billable status:

1. J86.0 - Pyothorax with Fistula: Yes, billable.
2. J86.9 - Pyothorax without Fistula: Yes, billable.
3. 3J86.8 - Other Pyothorax: Yes, billable.
4. J86.1 - Pyothorax with Effusion: Yes, billable.
5. J18.2 - Pneumonia, Unspecified Organism, with Empyema: Yes, billable.
6. J15.6 - Pneumonia due to other Gram-negative Bacteria, with Empyema: Yes, billable.
7. J85.1 - Abscess of Lung with Pneumonia: Yes, billable.
8. J85.0 - Gangrene and Necrosis of Lung with Pneumonia: Yes, billable.

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These ICD-10 codes for Empyema are billable, meaning they can be used for medical billing and reimbursement purposes when documenting cases of Empyema in patients. Proper coding ensures that healthcare providers receive appropriate payment for the services rendered and facilitates accurate tracking and analysis of the incidence and management of this serious medical condition.

Clinical Information

• Empyema is a serious medical condition characterized by the accumulation of pus in the pleural cavity, the space between the lungs and the inner chest wall. It is a complication that can arise from various infections, most commonly pneumonia, lung abscess, or chest trauma.
• The condition typically develops when the body's immune response to an infection is insufficient to clear the invading microorganisms, spreading bacteria or other pathogens into the pleural space.
• Common symptoms of empyema include severe chest pain, fever, chills, productive cough with foul-smelling or blood-tinged sputum, difficulty breathing (dyspnea), and a general feeling of illness (malaise).
• Empyema can be classified into three stages, each representing different phases of the infection and its progression:

• Exudative Stage: Initially, the pleural space contains a sterile exudate with increased white blood cells.
• Fibrinopurulent Stage: As the infection worsens, fibrin deposits form, and the exudate becomes infected with pus, causing inflammation and thickening of the pleura.
• Organizing Stage: In this stage, the body attempts to contain the infection by forming a fibrous peel or pleural rind, which can lead to lung entrapment.

• Diagnosis of empyema is typically based on a combination of clinical evaluation, chest X-rays, computed tomography (CT) scans, and thoracentesis (removal and analysis of pleural fluid). Imaging studies help visualize the extent of infection and complications such as lung abscesses or pleural thickening.
• Treatment of empyema usually requires hospitalization and a multidisciplinary approach involving pulmonologists, infectious disease specialists, and thoracic surgeons. The main goals of treatment are to eradicate the infection, drain the accumulated pus, and promote lung re-expansion.
• Antibiotic therapy is initiated promptly to target the causative microorganisms. Drainage of the pleural fluid is essential and can be achieved through thoracentesis, chest tube insertion, or video-assisted thoracoscopic surgery (VATS).

Synonyms Include

• Pyothorax
• Purulent pleuritis
• Pleural empyema
• Suppurative pleuritis
• Pleural purulent exudate
• Purulent pleural effusion