T26.20XA — Burn with resulting rupture and destruction of unspecified eyeball, initial encounter
Is T26.20XA billable?
Yes, but T26.20XA will trip a Medicare edit. T26.20XA is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists T26.20XA under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.
T26.20XA at a glance
| Code | T26.20XA |
|---|---|
| Description | Burn with resulting rupture and destruction of unspecified eyeball, initial encounter |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "A" | initial encounter |
What does the 7th character "A" mean in T26.20XA?
In T26.20XA, the 7th character A means initial encounter. The 7th character is required for T26.20XA to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
What Medicare edits apply to T26.20XA?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name T26.20XA directly.
A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.
Which MS-DRGs does T26.20XA group to?
T26.20XA sits in MDC 02 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 124Other Disorders of the Eye with MCC or Thrombolytic Agentmedical
- 125Other Disorders of the Eye without MCCmedical
As a secondary diagnosis, T26.20XA is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG. It also carries Hospital-Acquired Condition category 05.
How is T26.20XA listed in the Alphabetic Index?
The Alphabetic Index lists these routes under T26.2, the nearest indexed parent of T26.20XA. Use them to find the family, then select the specific code.
- Burn › eyeand adnexa › with resulting rupture and destruction of eyeball (electricity) (flame) (hot gas, liquid or hot object) (radiation) (steam) (thermal)
Use additional code — inherited from Chapter 19
Report an additional code alongside T26.20XA to fully describe the condition. T26.20XA is sequenced first.
- code to identify any retained foreign body, if applicable (Z18.-)
Use additional code — inherited from T26.2
Report an additional code alongside T26.20XA to fully describe the condition. T26.20XA is sequenced first.
Excludes2 — not included here — inherited from Chapter 19
The conditions below are not part of T26.20XA, but a patient may have both at the same time. When documentation supports it, T26.20XA and the excluded code may both be reported.
How long has T26.20XA existed?
T26.20XA has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.