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2025 ICD-10-CM code T85.84

Pain due to internal prosthetic devices, implants, or grafts.

Use additional codes to identify the type of device, implant, or graft, as well as the location and cause of the pain. If specific complications are identified, these should be coded separately.

Medical necessity for the evaluation and management of pain associated with internal devices would be supported by the presence of pain affecting the patient's functional status, requiring further investigation to rule out serious complications such as infection or mechanical failure of the device.

The clinical responsibility involves evaluating the patient's pain, identifying its source (e.g., through imaging or physical exam), and determining the appropriate management strategy, which may include pain management, revision surgery, infection control, or other interventions.

IMPORTANT:Consider using codes from Chapter 20 (External causes of morbidity) to specify the cause of injury or complication.If a retained foreign body is involved, use code Z18.- in addition. For specific complications of implants, more specific codes may be available.

In simple words: This code is for pain caused by something placed inside the body, like a joint replacement, a heart valve, or a bone graft. The pain might happen because the item is broken, infected, or the body is reacting to it. This code is only used if the pain is the main reason for the visit.

This code classifies pain resulting from internal prosthetic devices, implants, or grafts.It encompasses pain originating from any type of internal device, implant, or graft not otherwise specified.The pain may be caused by various factors, such as device malfunction, infection, or tissue reaction.This code should only be used when the pain is the primary reason for the encounter.

Example 1: A 65-year-old female presents with persistent pain in her right knee two years post-total knee arthroplasty.Imaging reveals no signs of infection or loosening, but there is evidence of slight wear and tear on the prosthetic components.The pain is the primary reason for the visit., A 70-year-old male presents with pain and swelling around a previously implanted cardiac pacemaker.Imaging reveals infection around the lead wires.The infection and pain are primary concerns., A 50-year-old female reports persistent back pain several months after spinal fusion surgery.The pain is not related to infection or any obvious device malfunction.Other possibilities, like nerve irritation, are explored.

Detailed history of the implant procedure, including date, type of implant, and surgeon.Documentation of the pain (location, duration, intensity, character), physical examination findings, imaging reports (X-rays, CT scans, MRI), and any laboratory results (e.g., inflammatory markers if infection is suspected).Detailed description of treatment plan.

** This code is no longer valid for use.Clinicians should use more specific codes to describe the nature of the complication and the type of implant involved.For example, if the pain is related to a specific device failure or infection, specific codes for those conditions should be used instead.

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