T88.52XA — Failed moderate sedation during procedure, initial encounter
T88.52XA is a billable, specific ICD-10-CM code for failed moderate sedation during procedure, 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 T88
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Excludes2 — not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
- personal history of failed moderate sedation (Z92.83)
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Failed conscious sedation during procedure
Risk adjustment
T88.52XA 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
T88.52XA is named in 2 Medicare coverage policies — 2 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A57206Billing and Coding: Lumbar MRI
- A57361Billing and Coding: Monitored Anesthesia Care
Related codes at this level
Codes that share T88.52. If T88.52XA is not quite right, the correct code is usually one of these.
Questions about T88.52XA
- Is T88.52XA a billable ICD-10-CM code?
- Yes. T88.52XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does T88.52XA 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).