T85.21XS
T85.21XS — Breakdown (mechanical) of intraocular lens, sequela
Billable / specific codeICD-10-CMPOA exempt
T85.21XS is a billable, specific ICD-10-CM code for breakdown (mechanical) of intraocular lens, 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
T85.21XS 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
T85.21XS is named in 4 Medicare coverage policies — 4 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
- A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
- A56549Billing and Coding: Ophthalmic Biometry for Intraocular Lens Power Calculation
- A57204Billing and Coding: MRI and CT Scans of the Head and Neck
Related codes at this level
Codes that share T85.21. If T85.21XS is not quite right, the correct code is usually one of these.
Questions about T85.21XS
- Is T85.21XS a billable ICD-10-CM code?
- Yes. T85.21XS is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does T85.21XS 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).