T85 vs Z96
T85 (Complications of other internal prosthetic devices, implants and grafts) compared with Z96 (Presence of other functional implants), from the official CMS tabular data. Both may be reported when both conditions are documented (Excludes2).
Can these codes be reported together?
Yes, when both are documented. Z96 carries an Excludes2 note covering T85: “complications of internal prosthetic devices, implants and grafts (T82-T85)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
Side by side
| T85Complications of other internal prosthetic devices, implants and grafts | Z96Presence of other functional implants | |
|---|---|---|
| Billing status | Non-billable header Report instead: T85.01XA, T85.01XD, T85.01XS, T85.02XA, T85.02XD | Non-billable header |
| Classification | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) | Z00-Z99 — Factors Influencing Health Status and Contact with Health Services (Z00-Z99) |
| Definition | Complications of other internal prosthetic devices, implants and grafts is a non-billable ICD-10-CM category code (T85). | Presence of other functional implants is a non-billable ICD-10-CM category code (Z96). |
| 7th character | The appropriate 7th character is to be added to each code from category T85 | — |
| Use additional code | 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 to identify devices involved and details of circumstances (Y62-Y82) | — |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources