2025 ICD-10-CM code T84.5
Infection and inflammatory reaction due to internal joint prosthesis.
Medical necessity is established by the presence of an infection or inflammatory reaction that is directly related to the internal joint prosthesis. The documentation should support the need for treatment to resolve the infection/inflammation and prevent potential complications.
The physician is responsible for diagnosing the infection and inflammation, determining the cause, and providing appropriate treatment, which may include antibiotics, surgical intervention, or other medical management.
In simple words: This code represents an infection or inflammation related to an artificial joint replacement.
Infection and inflammatory reaction due to internal joint prosthesis. Use additional code to identify infection.
Example 1: A patient presents with pain, swelling, and redness around their knee replacement. After examination and testing, the physician diagnoses an infection related to the prosthesis., A patient experiences persistent inflammation around their hip replacement, despite initial treatment. Further investigation reveals a reaction to the prosthetic material., During a routine follow-up, a patient's bloodwork indicates signs of infection. Imaging reveals inflammation surrounding their internal joint prosthesis.
Documentation should include evidence of infection or inflammation, such as physical exam findings, laboratory results (e.g., elevated white blood cell count, positive cultures), and imaging studies. The relationship between the infection/inflammation and the internal joint prosthesis must be clearly documented.
** Excludes2: failure and rejection of transplanted organs and tissues (T86.-) and fracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate (M96.6).
- Specialties:Orthopedic Surgery, Infectious Disease
- Place of Service:Inpatient Hospital, On Campus-Outpatient Hospital, Off Campus-Outpatient Hospital, Physician's Office