T80-T88 — Complications of surgical and medical care, not elsewhere classified
ICD-10-CM codes T80-T88 cover complications of surgical and medical care, not elsewhere classified, within injury, poisoning and certain other consequences of external causes. The block holds 2,383 codes across 9 categories, of which 1,683 are billable and 700 are header codes that cannot be submitted on a claim. 2,252 of them (95%) require a 7th character.
Excludes2 — not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
- 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)
Use additional code
Add a secondary code to capture the detail described below.
The 7th character in T80-T88
A code in this block is not complete without its 7th character, and a missing one is a rejected claim rather than a denied one: the clearinghouse never passes it on. 2,252 of the 2,383 codes here take one.
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Risk adjustment in T80-T88
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 409 Amputation Status, Lower Limb/Amputation Complications
- HCC 221 Heart Transplant Status/Complications
- HCC 276 Lung Transplant Status/Complications
- HCC 454 Stem Cell, Including Bone Marrow, Transplant Status/Complications
- HCC 405 Traumatic Amputations and Complications
- HCC 62 Liver Transplant Status/Complications
What else to watch in T80-T88
- 525 codes are laterality-specific. They come in left and right pairs, and the pair is mutually exclusive on a single site: coding both without a bilateral code is a contradiction a scrubber should catch before the payer does.
- 1,597 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.
Categories in T80-T88
- T80Complications following infusion, transfusion and therapeutic injection
- T81Complications of procedures, not elsewhere classified
- T82Complications of cardiac and vascular prosthetic devices, implants and grafts
- T83Complications of genitourinary prosthetic devices, implants and grafts
- T84Complications of internal orthopedic prosthetic devices, implants and grafts
- T85Complications of other internal prosthetic devices, implants and grafts
- T86Complications of transplanted organs and tissue
- T87Complications peculiar to reattachment and amputation
- T88Other complications of surgical and medical care, not elsewhere classified