2025 ICD-10-CM code T85
Complications of other internal prosthetic devices, implants and grafts.
Medical necessity must be established by demonstrating that the complication is a direct result of the internal prosthetic device, implant, or graft, and that the treatment provided is necessary to address the complication. Payer-specific guidelines and documentation requirements must be adhered to.
Clinical responsibility for complications due to internal prosthetic devices, implants and grafts involves diagnosing, managing, and treating conditions such as infection, mechanical failure, erosion, or other adverse reactions. This might include ordering imaging studies, prescribing medications (e.g., antibiotics), performing surgical revisions or removals, and providing ongoing care.
- Injury, poisoning and certain other consequences of external causes (S00-T88)
- Injury, poisoning and certain other consequences of external causes (T07-T88)
In simple words: Problems or complications arising from internal prosthetic devices, implants, or grafts, except for organ or tissue transplants.
Complications of other internal prosthetic devices, implants and grafts. Excludes2: failure and rejection of transplanted organs and tissue (T86.-)
Example 1: A patient with a prosthetic heart valve develops endocarditis (infection of the heart valve). The T85 code would be used to report the complication related to the prosthetic valve., A patient with a pacemaker experiences lead displacement, causing the pacemaker to malfunction. The T85 code would be used to report this complication., A patient with a vascular graft develops an infection at the graft site. The T85 code would be used to report the complication related to the vascular graft.
Documentation should clearly specify the type of prosthetic device, implant, or graft involved, the nature of the complication, and the relationship between the complication and the device. Supporting evidence such as imaging studies, laboratory results, and operative reports should be included. Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5); code(s) to identify the specified condition resulting from the complication; code to identify devices involved and details of circumstances (Y62-Y82). Use additional code to identify any retained foreign body, if applicable (Z18.-).
- Specialties:The specialties involved will depend on the type of implant and the resulting complication but may include cardiology (for heart valves and pacemakers), vascular surgery (for vascular grafts), orthopedics (for joint replacements), and general surgery.
- Place of Service:Inpatient Hospital, On Campus-Outpatient Hospital, Off Campus-Outpatient Hospital,Physician's Office,Ambulatory Surgical Center and others based on the specific scenario.