T85.21XA
T85.21XA — Breakdown (mechanical) of intraocular lens, initial encounter
Billable / specific codeICD-10-CM
T85.21XA is a billable, specific ICD-10-CM code for breakdown (mechanical) of intraocular lens, initial encounter. It is valid for submission on a claim.
7th character "A" — initial encounter
The appropriate 7th character is to be added to each code from category T85
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Risk adjustment
T85.21XA does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
T85.21XA is named in 10 Medicare coverage policies — 10 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
- A56439Billing and Coding: Blepharoplasty
- A56493Billing and Coding: Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy
- A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Related codes at this level
Codes that share T85.21. If T85.21XA is not quite right, the correct code is usually one of these.
Questions about T85.21XA
- Is T85.21XA a billable ICD-10-CM code?
- Yes. T85.21XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does T85.21XA sit in the tabular list?
- Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Complications of surgical and medical care, not elsewhere classified (T80-T88).