T85.638A — Leakage of other specified internal prosthetic devices, implants and grafts, initial encounter
Is T85.638A billable?
Yes, but T85.638A is an unspecified code. T85.638A is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, T85.638A is an unspecified or catch-all code. Payers apply additional scrutiny to unspecified codes and many deny them when the medical record supports a more specific option, so check the documentation before selecting T85.638A — the more specific alternatives are listed below.
More specific alternatives
- T85.01XABreakdown (mechanical) of ventricular intracranial (communicating) shunt, initial encounter
- T85.110ABreakdown (mechanical) of implanted electronic neurostimulator of brain electrode (lead), initial encounter
- T85.21XABreakdown (mechanical) of intraocular lens, initial encounter
- T85.310ABreakdown (mechanical) of prosthetic orbit of right eye, initial encounter
- T85.41XABreakdown (mechanical) of breast prosthesis and implant, initial encounter
- T85.510ABreakdown (mechanical) of bile duct prosthesis, initial encounter
- T85.71XAInfection and inflammatory reaction due to peritoneal dialysis catheter, initial encounter
T85.638A at a glance
| Code | T85.638A |
|---|---|
| Description | Leakage of other specified internal prosthetic devices, implants and grafts, 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 T85.638A?
In T85.638A, the 7th character A means initial encounter. The 7th character is required for T85.638A to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
Which MS-DRGs does T85.638A group to?
T85.638A sits in MDC 21 and helps define the logic of 3 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 919Complications of Treatment with MCCmedical
- 920Complications of Treatment with CCmedical
- 921Complications of Treatment without CC/MCCmedical
As a secondary diagnosis, T85.638A is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is T85.638A listed in the Alphabetic Index?
The Alphabetic Index lists these routes under T85.638, the nearest indexed parent of T85.638A. Use them to find the family, then select the specific code.
- Leak, leakage › device, implant or graft › catheter NEC
- Leak, leakage › device, implant or graft › specified NEC
- Complication › prosthetic device or implant › specified NEC › mechanical › leakage (s) (from) (of)
Use additional code — inherited from Chapter 19
Report an additional code alongside T85.638A to fully describe the condition. T85.638A is sequenced first.
- code to identify any retained foreign body, if applicable (Z18.-)
Use additional code — inherited from T80-T88
Report an additional code alongside T85.638A to fully describe the condition. T85.638A is sequenced first.
Excludes2 — not included here — inherited from Chapter 19
The conditions below are not part of T85.638A, but a patient may have both at the same time. When documentation supports it, T85.638A and the excluded code may both be reported.
Excludes2 — not included here — inherited from T80-T88
The conditions below are not part of T85.638A, but a patient may have both at the same time. When documentation supports it, T85.638A and the excluded code may both be reported.
- any encounters with medical care for postprocedural conditions in which no complications are present, such as:
- artificial opening status (Z93.-)
- closure of external stoma (Z43.-)
- fitting and adjustment of external prosthetic device (Z44.-)
- burns and corrosions from local applications and irradiation (T20-T32)
- complications of surgical procedures during pregnancy, childbirth and the puerperium (O00-O9A)
- mechanical complication of respirator [ventilator] (J95.850)
- poisoning and toxic effects of drugs and chemicals (T36-T65 with fifth or sixth character 1-4 or 6)
- postprocedural fever (R50.82)
- specified complications classified elsewhere, such as:
- cerebrospinal fluid leak from spinal puncture (G97.0)
- colostomy malfunction (K94.0-)
- disorders of fluid and electrolyte imbalance (E86-E87)
- functional disturbances following cardiac surgery (I97.0-I97.1)
- intraoperative and postprocedural complications of specified body systems (D78.-, E36.-, E89.-, G97.3-, G97.4, H59.3-, H59.-, H95.2-, H95.3, I97.4-, I97.5, J95.6-, J95.7, K91.6-, L76.-, M96.-, N99.-)
- ostomy complications (J95.0-, K94.-, N99.5-)
- postgastric surgery syndromes (K91.1)
- postlaminectomy syndrome NEC (M96.1)
- postmastectomy lymphedema syndrome (I97.2)
- postsurgical blind-loop syndrome (K91.2)
- ventilator associated pneumonia (J95.851)
Excludes2 — not included here — inherited from T85
The conditions below are not part of T85.638A, but a patient may have both at the same time. When documentation supports it, T85.638A and the excluded code may both be reported.
- failure and rejection of transplanted organs and tissue (T86.-)
How long has T85.638A existed?
T85.638A 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.