T81.42XA

T81.42XA: Infection following a procedure, deep incisional surgical site, initial encounter

Billable / specific codeICD-10-CM

T81.42XA is a billable, specific ICD-10-CM code for infection following a procedure, deep incisional surgical site, initial encounter. It is valid for submission on a claim.

Check T81.42XA with the rest of the claim: free scrubber

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

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Intra-muscular abscess following a procedure

Excludes2 inherited from the categories above T81.42XA

Not part of this code, but both may be coded when both are present.

Written on T81.4: Infection following a procedure

bleb associated endophthalmitis (H59.4-)
infection due to infusion, transfusion and therapeutic injection (T80.2-)
infection due to prosthetic devices, implants and grafts (T82.6-T82.7, T83.5-T83.6, T84.5-T84.7, T85.7)
obstetric surgical wound infection (O86.0-)
postprocedural fever NOS (R50.82)
postprocedural retroperitoneal abscess (K68.11)

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

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

T81.42XA is named in 16 Medicare coverage policies: 16 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A53057Billing and Coding: Home Health Occupational Therapy
A53064Billing and Coding: Outpatient Occupational Therapy
A55336Billing and Coding: Retroperitoneal Ultrasound
A55909Billing and Coding: Wound Care

Code history

Unchanged in every release from FY2024 to FY2027.