T85.318S
T85.318S — Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, sequela
Billable / specific codeICD-10-CMPOA exempt
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)
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).