Is T84.011A a billable ICD-10-CM code?

Yes. T84.011A is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does T84.011A 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 T84.011A?

T84.011A 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 T84.011A (T84.01) and apply to it just the same.

T84.011A

T84.011A — Broken internal left hip prosthesis, initial encounter

Billable / specific codeICD-10-CMleft

T84.011A is a billable, specific ICD-10-CM code for broken internal left hip prosthesis, 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 T84

A: initial encounter
D: subsequent encounter
S: sequela

Excludes1 inherited from the categories above T84.011A

These are not written on T84.011A, but they bind it: a note on a category applies to every code beneath it. Billing T84.011A with anything listed here is a denial.

Written on T84.01 — Broken internal joint prosthesis

periprosthetic joint implant fracture (M97.-)

Excludes2 inherited from the categories above T84.011A

Also inherited, and the opposite of Excludes1: these conditions are not part of T84.011A, but a patient can have both, so you may code both.

Written on T84 — Complications of internal orthopedic prosthetic devices, implants and grafts

failure and rejection of transplanted organs and tissues (T86.-)
fracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate (M96.6)

Risk adjustment

T84.011A 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

T84.011A is named in 9 Medicare coverage policies — 9 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A56777Billing and Coding: Total Joint Arthroplasty
A56796Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
A57206Billing and Coding: Lumbar MRI
A57311Billing and Coding: Physical Therapy - Home Health

Code history

T84.011A 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 T84.011. If T84.011A is not quite right, the correct code is usually one of these.

Questions about T84.011A

Is T84.011A a billable ICD-10-CM code?: Yes. T84.011A is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does T84.011A 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 T84.011A?: T84.011A 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 T84.011A (T84.01) and apply to it just the same.