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T81.49XA vs T85.7

T81.49XA (Infection following a procedure, other surgical site, initial encounter) compared with T85.7 (Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts), from the official CMS tabular data.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Summary

These codes can be reported together when both conditions are documented, because T81.49XA lists T85.7 under Excludes2, which marks them as distinct conditions.

Official rule
What is different?

The conditions named and billing status.T81.49XA is “Infection following a procedure, other surgical site, initial encounter”; T85.7 is “Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts”. T85.7 is a non-billable header; T81.49XA is billable.

Registry fact

Can these codes be reported together?

Yes, when both are documented.T81.49XA lists T85.7 under Excludes2: “infection due to prosthetic devices, implants and grafts (T82.6-T82.7, T83.5-T83.6, T84.5-T84.7, T85.7)”. Excludes2 marks distinct conditions that may both be reported when both are documented.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

None.Neither entry carries an Excludes1 note that names the other code.

Official rule

Is there an Excludes2 relationship?

Yes.T81.49XA’s tabular entry: “infection due to prosthetic devices, implants and grafts (T82.6-T82.7, T83.5-T83.6, T84.5-T84.7, T85.7)”. The note covers T85.7.

Official ruleGuide: Excludes1 vs Excludes2

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Is one a parent or header code?

One is a header.T85.7 is a non-billable header, but T81.49XA is not one of its subdivisions.

Registry fact

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Informational

Excludes2 relationship

T81.49XA
Infection following a procedure, other surgical site, initial encounter
↔
T85.7
Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts

What we found

Yes, when both are documented.T81.49XA carries an Excludes2 note covering T85.7: “infection due to prosthetic devices, implants and grafts (T82.6-T82.7, T83.5-T83.6, T84.5-T84.7, T85.7)”

Excludes2 marks distinct conditions — both may be reported when both are documented.

What to review

Report both only when the documentation supports both conditions; otherwise report the one documented.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes2 note means the excluded condition is not part of the code above it, but a patient can have both. Report both when both are documented.

Source / rule

CMS ICD-10-CM tabular instructional notes

Official guidance behind these answers

  • Section I.A.12.b — Excludes2 · applies to: Excludes2

    A type 2 Excludes note represents “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

    ICD-10-CM Official Guidelines FY2027

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

Similar descriptions do not make codes interchangeable. The documentation and the official instructions decide which code applies.

Official descriptionDiffers
T81.49XA

Infection following a procedure, other surgical site, initial encounter

T85.7

Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts

StatusDiffers
T81.49XA
Billable
T85.7
Non-billable header

A header is not reported on a claim; a code beneath it is.

Report instead: T85.71XA, T85.71XD, T85.71XS, T85.72XA, T85.72XD

Excludes2Differs
T81.49XA
  • bleb associated endophthalmitis (H59.4-)
  • infection due to infusion, transfusion and therapeutic injection (T80.2-)
  • infection due to prosthetic devices, implants and grafts (T82.6-T82.7, T83.5-T83.6, T84.5-T84.7, T85.7)
  • obstetric surgical wound infection (O86.0-)
  • postprocedural fever NOS (R50.82)
  • postprocedural retroperitoneal abscess (K68.11)
  • complications following immunization (T88.0-T88.1)
  • complications following infusion, transfusion and therapeutic injection (T80.-)
  • complications of transplanted organs and tissue (T86.-)
  • specified complications classified elsewhere, such as:
  • complication of prosthetic devices, implants and grafts (T82-T85)
  • dermatitis due to drugs and medicaments (L23.3, L24.4, L25.1, L27.0-L27.1)
  • endosseous dental implant failure (M27.6-)
  • floppy iris syndrome (IFIS) (intraoperative) H21.81
  • intraoperative and postprocedural complications of specific body system (D78.-, E36.-, E89.-, G97.3-, G97.4, H59.3-, H59.-, H95.2-, H95.3, I97.4-, I97.5, J95, K91.-, L76.-, M96.-, N99.-)
  • ostomy complications (J95.0-, K94.-, N99.5-)
  • plateau iris syndrome (post-iridectomy) (postprocedural) H21.82
  • poisoning and toxic effects of drugs and chemicals (T36-T65 with fifth or sixth character 1-4)
  • any encounters with medical care for postprocedural conditions in which no complications are present, such as:
  • artificial opening status (Z93.-)
  • closure of external stoma (Z43.-)
  • fitting and adjustment of external prosthetic device (Z44.-)
  • burns and corrosions from local applications and irradiation (T20-T32)
  • complications of surgical procedures during pregnancy, childbirth and the puerperium (O00-O9A)
  • mechanical complication of respirator [ventilator] (J95.850)
  • poisoning and toxic effects of drugs and chemicals (T36-T65 with fifth or sixth character 1-4 or 6)
  • postprocedural fever (R50.82)
  • cerebrospinal fluid leak from spinal puncture (G97.0)
  • colostomy malfunction (K94.0-)
  • disorders of fluid and electrolyte imbalance (E86-E87)
  • functional disturbances following cardiac surgery (I97.0-I97.1)
  • intraoperative and postprocedural complications of specified body systems (D78.-, E36.-, E89.-, G97.3-, G97.4, H59.3-, H59.-, H95.2-, H95.3, I97.4-, I97.5, J95.6-, J95.7, K91.6-, L76.-, M96.-, N99.-)
  • postgastric surgery syndromes (K91.1)
  • postlaminectomy syndrome NEC (M96.1)
  • postmastectomy lymphedema syndrome (I97.2)
  • postsurgical blind-loop syndrome (K91.2)
  • ventilator associated pneumonia (J95.851)
T85.7
  • failure and rejection of transplanted organs and tissue (T86.-)
  • any encounters with medical care for postprocedural conditions in which no complications are present, such as:
  • artificial opening status (Z93.-)
  • closure of external stoma (Z43.-)
  • fitting and adjustment of external prosthetic device (Z44.-)
  • burns and corrosions from local applications and irradiation (T20-T32)
  • complications of surgical procedures during pregnancy, childbirth and the puerperium (O00-O9A)
  • mechanical complication of respirator [ventilator] (J95.850)
  • poisoning and toxic effects of drugs and chemicals (T36-T65 with fifth or sixth character 1-4 or 6)
  • postprocedural fever (R50.82)
  • specified complications classified elsewhere, such as:
  • cerebrospinal fluid leak from spinal puncture (G97.0)
  • colostomy malfunction (K94.0-)
  • disorders of fluid and electrolyte imbalance (E86-E87)
  • functional disturbances following cardiac surgery (I97.0-I97.1)
  • intraoperative and postprocedural complications of specified body systems (D78.-, E36.-, E89.-, G97.3-, G97.4, H59.3-, H59.-, H95.2-, H95.3, I97.4-, I97.5, J95.6-, J95.7, K91.6-, L76.-, M96.-, N99.-)
  • ostomy complications (J95.0-, K94.-, N99.5-)
  • postgastric surgery syndromes (K91.1)
  • postlaminectomy syndrome NEC (M96.1)
  • postmastectomy lymphedema syndrome (I97.2)
  • postsurgical blind-loop syndrome (K91.2)
  • ventilator associated pneumonia (J95.851)
Use additional codeDiffers
T81.49XA
  • code to identify infection
  • code (R65.2-) to identify severe sepsis, if applicable
  • code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
T85.7
  • code to identify infection
  • code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
  • code(s) to identify the specified condition resulting from the complication
Code alsoDiffers
T81.49XA
  • , if applicable, disruption of internal operation (surgical) wound (T81.32-)
T85.7

None at this code

CategoryDiffers
T81.49XA

T81 Complications of procedures, not elsewhere classified

T85.7

T85 Complications of other internal prosthetic devices, implants and grafts

ChapterSame for both

S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)

7th characterDiffers
T81.49XA
  • The appropriate 7th character is to be added to each code from category T81
T85.7
  • The appropriate 7th character is to be added to each code from category T85

No Excludes1, Code first and Includes note at either code.

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on. In a row that differs, notes every code shares are dimmed.

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Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources