Is T85.612S a billable ICD-10-CM code?

Yes. T85.612S is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does T85.612S 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 T85.612S?

T85.612S carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

T85.612S

T85.612S — Breakdown (mechanical) of permanent sutures, sequela

Billable / specific codeICD-10-CMPOA exempt

T85.612S is a billable, specific ICD-10-CM code for breakdown (mechanical) of permanent sutures, 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

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

mechanical complication of permanent (wire) suture used in bone repair (T84.1-T84.2)

Risk adjustment

T85.612S 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

T85.612S is named in 5 Medicare coverage policies — 5 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
A57204Billing and Coding: MRI and CT Scans of the Head and Neck

Related codes at this level

Codes that share T85.612. If T85.612S is not quite right, the correct code is usually one of these.

Questions about T85.612S

Is T85.612S a billable ICD-10-CM code?: Yes. T85.612S is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does T85.612S 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 T85.612S?: T85.612S carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.