2025 ICD-10-CM code T85.7
Infection and inflammatory reaction due to other internal prosthetic devices, implants, and grafts.
Modifiers may be applicable depending on the circumstances of service and the specific procedure performed. Consult the most current modifier guidelines.
Medical necessity is established by the presence of a clinically significant infection or inflammatory reaction directly attributable to an internal prosthetic device, implant, or graft.This necessitates appropriate medical intervention to address the complication, improve the patient's condition, and prevent more serious consequences.
The clinical responsibility lies with the physician managing the patient's infection and inflammatory reaction. This includes diagnosing the condition, ordering appropriate investigations (such as cultures and imaging), initiating treatment (e.g., antibiotics, surgical debridement), and monitoring the patient's response to therapy.
- Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88)
- T85.7 falls under the broader category of complications of medical care, specifically infections and inflammatory reactions related to internal prosthetic devices, implants, or grafts.It is further specified by additional codes to reflect the involved device and the nature of the complication.
In simple words: This code is used when you have an infection or inflammation because of something that was put inside your body, like a joint replacement, a heart valve, or a similar device. This code requires additional information on what was implanted and the specifics of the infection.
This ICD-10-CM code classifies infections and inflammatory reactions resulting from the presence of internal prosthetic devices, implants, or grafts, excluding those specifically categorized elsewhere.It encompasses a range of reactions, from localized inflammation to systemic infections, triggered by the foreign material.The code necessitates further specification using additional codes to identify the specific implant, device, or graft involved, as well as any related infections.
Example 1: A 72-year-old female patient presents with pain, swelling, and redness around her right hip, three months post-total hip arthroplasty.Cultures reveal Staphylococcus aureus.The code T85.7 would be used in conjunction with codes specifying the infection and the implanted hip prosthesis., A 55-year-old male patient experiences fever, chills, and fatigue two weeks following a coronary artery bypass graft (CABG) procedure. Blood cultures are positive for Streptococcus viridans.T85.7 would be used alongside codes detailing the infection and the specific cardiac implant., A 30-year-old patient who received an internal fixation device following a fracture develops localized inflammation and pain at the fracture site.While no infection is present, the inflammatory reaction is attributed to the implant. T85.7 would be appropriate here.
Detailed documentation is required including:Patient's history, physical examination findings, laboratory results (blood cultures, wound cultures), imaging studies (X-rays, CT scans), details of the implanted device or graft, type of infection or inflammation, treatment rendered, and patient's response to treatment.All documentation must support the medical necessity of the procedure and diagnosis.
** Always use the most specific code available.This code should be used only if the infection or inflammation is directly related to the implanted device or graft.If the infection or inflammation is caused by another factor, appropriate codes for the underlying cause should also be used. The seventh character (A, D, or S) should be appended to indicate the encounter status (initial, subsequent, or sequela).
- Payment Status: Active
- Modifier TC rule: The application of a technical component (TC) modifier depends on the context of the service, specifically whether a physician's service is separate from the technical aspects of the procedure.This is determined case by case.
- Specialties:Orthopedics, Cardiology, General Surgery, Infectious Disease
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Physician's Office