Empyema/Lung Abscess

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains how a specific CMS-HCC v28 category is organized and where it fits within risk adjustment, with additional guidance on documentation review and outpatient reporting considerations. It is aimed at coding, CDI, and compliance professionals who need to understand the general scope of the condition group, the associated ICD-10-CM inclusion list, and the surrounding audit-focused context without relying on premium content.

Why This Topic Matters

Accurate classification of this category can affect risk adjustment and compliance review. The page also highlights why documentation status and post-discharge reporting matter for conditions that may be mistaken as ongoing when they are no longer active.

Article Sections

  1. CMS-HCC v28

    Introduces the risk-adjustment category and places it within the CMS-HCC v28 framework. Includes hierarchy context and the associated ICD-10-CM inclusion set at a high level.

  2. CDI Critical Thinking

    Provides general documentation integrity themes related to risk adjustment, post-discharge reporting, history-versus-active status, and outpatient review considerations. Also discusses broader audit and problem-list awareness topics.

  3. Sample Query

    Shows an example of a documentation clarification scenario involving the condition status after hospitalization. The example is framed as a query template rather than a coding rule.

  4. CMS-HCC v28

    Restates the category name within the CMS-HCC v28 listing. Serves as a brief identification of the same risk-adjustment topic.

  5. HHS-HCC

    Indicates whether the topic is addressed in the HHS-HCC framework. In this article, it is shown as not applicable.

  6. Elixhauser Comorbidity Index

    Indicates whether the topic is addressed in the Elixhauser Comorbidity Index framework. In this article, it is shown as not applicable.

  7. HEDIS: Advanced Illness/Frailty

    Indicates whether the topic is addressed in the HEDIS advanced illness/frailty context. In this article, it is shown as not applicable.

What You Will Learn

  • How the article positions the topic within CMS-HCC v28 risk adjustment
  • What broader documentation and CDI themes are associated with this condition group
  • How the page frames outpatient review and post-discharge status clarification
  • Which related code set is referenced for inclusion in the category
  • How the article relates to other classification frameworks and indices

Who Should Read This

  • Medical coders
  • CDI specialists
  • Risk adjustment professionals
  • Compliance auditors
  • Physician documentation review staff

Codes Discussed

Code Ranges Discussed

  • ICD-10-CM: J85.-
  • ICD-10-CM: J86.-

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Get the resource CDI Professionals trust! The ACDIS Outpatient Pocket Guide covers over 80 highly pertinent topics with in-depth information including:

  • Definitions
  • Diagnostic Criteria
  • MEAT
  • Coding Considerations
  • CDI
  • Provider tips
  • Sample Queries
  • HCCs (CMS v28 and HHS v08)
  • ECI & HEDIS
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