T85.318S — Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, sequela
T85.318S is a billable, specific ICD-10-CM code for breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, sequela. It is valid for submission on a claim.
7th character "S" — sequela
The appropriate 7th character is to be added to each code from category T85
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Risk adjustment
T85.318S 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
T85.318S is named in 7 Medicare coverage policies — 7 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53057Billing and Coding: Home Health Occupational Therapy
- A53058Billing and Coding: Home Health Physical Therapy
- A53064Billing and Coding: Outpatient Occupational Therapy
- A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Code history
T85.318S has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share T85.318. If T85.318S is not quite right, the correct code is usually one of these.
Questions about T85.318S
- Is T85.318S a billable ICD-10-CM code?
- Yes. T85.318S is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does T85.318S 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).