T81.31XA — Disruption of external operation (surgical) wound, not elsewhere classified, initial encounter
T81.31XA is a billable, specific ICD-10-CM code for disruption of external operation (surgical) wound, not elsewhere classified, 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 T81
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Excludes1 — never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- dehiscence of amputation stump (T87.81)
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Dehiscence of operation wound NOS
- Disruption of operation wound NOS
- Disruption or dehiscence of closure of cornea
- Disruption or dehiscence of closure of mucosa
- Disruption or dehiscence of closure of skin and subcutaneous tissue
- Full-thickness skin disruption or dehiscence
- Superficial disruption or dehiscence of operation wound
Excludes1 inherited from the categories above T81.31XA
These are not written on T81.31XA, but they bind it: a note on a category applies to every code beneath it. Billing T81.31XA with anything listed here is a denial.
Written on T81.31 — Disruption of external operation (surgical) wound, not elsewhere classified
- dehiscence of amputation stump (T87.81)
Written on T81.3 — Disruption of wound, not elsewhere classified
Excludes2 inherited from the categories above T81.31XA
Also inherited, and the opposite of Excludes1: these conditions are not part of T81.31XA, but a patient can have both, so you may code both.
Written on T81 — Complications of procedures, not elsewhere classified
- complications following immunization (T88.0-T88.1)
- complications following infusion, transfusion and therapeutic injection (T80.-)
- complications of transplanted organs and tissue (T86.-)
- specified complications classified elsewhere, such as:
- complication of prosthetic devices, implants and grafts (T82-T85)
- dermatitis due to drugs and medicaments (L23.3, L24.4, L25.1, L27.0-L27.1)
- endosseous dental implant failure (M27.6-)
- floppy iris syndrome (IFIS) (intraoperative) H21.81
- intraoperative and postprocedural complications of specific body system (D78.-, E36.-, E89.-, G97.3-, G97.4, H59.3-, H59.-, H95.2-, H95.3, I97.4-, I97.5, J95, K91.-, L76.-, M96.-, N99.-)
- ostomy complications (J95.0-, K94.-, N99.5-)
- plateau iris syndrome (post-iridectomy) (postprocedural) H21.82
- poisoning and toxic effects of drugs and chemicals (T36-T65 with fifth or sixth character 1-4)
Risk adjustment
T81.31XA 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
T81.31XA is named in 8 Medicare coverage policies — 6 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56566Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
- A57067Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
- A55909Billing and Coding: Wound Care
- A56421Billing and Coding: CT of the Abdomen and Pelvis
Code history
T81.31XA 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 T81.31. If T81.31XA is not quite right, the correct code is usually one of these.
Questions about T81.31XA
- Is T81.31XA a billable ICD-10-CM code?
- Yes. T81.31XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does T81.31XA 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).
- What cannot be coded together with T81.31XA?
- T81.31XA carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above T81.31XA (T81.31, T81.3) and apply to it just the same.