T85.638A ICD-10-CM Code: Leakage of other specified internal prosthetic devices, implants and grafts, initial encounter

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for T85.638A in the official ICD-10-CM tabular list, quoted as published.

Notes without a marker are published on T85.638A itself; “inherited from” names the category or block whose note applies here.

7th Character Guide

"The appropriate 7th character is to be added to each code from category T85"

• A — initial encounter (this page’s code)
• D — subsequent encounter
• S — sequela

How the encounter character is assigned. “Initial encounter” means the patient is receiving active treatment for the condition — it is not limited to the first visit, and a different or new provider giving active treatment still assigns it. “Subsequent encounter” covers care during the healing or recovery phase after active treatment. “Sequela” is for complications or conditions that arise as a direct result of the original condition.

ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.a (paraphrased by MedCoder).

Variant codes in this family

T85.638A, T85.638D, T85.638S

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Coder workflow for T85.638A

MedCoder structured workflow — derived from this code’s own official record

Before you code T85.638A

1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on T85.638A; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

   ReviewT85.630A, T85.631A, T85.633A, T85.635A

   See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

2. A 7th character is required in this family. Confirm the documented encounter: initial (active treatment), subsequent (healing or recovery phase), or sequela. This page’s code carries “A”. “Initial” means active treatment, not the first visit (Guidelines I.C.19.a).

   See the 7th Character Guide · Guide: 7th characters: initial, subsequent, sequela →

Choose the right path

1. Is the encounter phase documented — active treatment, healing or recovery, or a sequela?
   Yes → Assign the matching 7th character; the variant codes are in the 7th Character Guide.
   No → The code is invalid without its 7th character — query for the missing element.

Consider T85.638A. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Encounter type

Active treatment, healing or recovery phase, or sequela — the basis of the 7th character (Guidelines I.C.19.a).

The conditions the Use Additional Code note names

Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Any detail beyond this code’s title

What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

• Excludes2 — not part of T85.638A(22 notes)

  Coding workflow: The conditions named in this note are not included in T85.638A. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareT86, Z93, Z43, Z44, R50.82, G97.0

  See the official tabular notes · Guidelines I.A.12.b

• Use Additional Code — after identifying T85.638A(3 notes)

  Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with T85.638A when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

  See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Complication (s) (from) (of), prosthetic device or implant, specified NEC, mechanical, leakage
• Leak, leakage, device, implant or graft, catheter NEC
• Leak, leakage, device, implant or graft, specified NEC

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Don’t confuse T85.638A with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of T85.638A — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• T85.638D— Encounter relationship (Review)

  Same underlying diagnosis, different encounter phase.

  The same diagnosis at a different phase of care; one encounter takes one 7th character.

  What moves you there: Documentation of a subsequent encounter moves the case to T85.638D.

  Full comparison: T85.638A vs T85.638D →

• T85.638S— Encounter relationship (Review)

  Same underlying diagnosis, different encounter phase.

  The same diagnosis at a different phase of care; one encounter takes one 7th character.

  What moves you there: Documentation of a sequela moves the case to T85.638S.

  Full comparison: T85.638A vs T85.638S →

• T86— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of failure and rejection of transplanted organs and tissue adds T86; it is not part of this code and both may be reported when both are documented.

  Full comparison: T85.638A vs T86 →

• Z93— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of artificial opening status adds Z93; it is not part of this code and both may be reported when both are documented.

  Full comparison: T85.638A vs Z93 →

• Z43— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of closure of external stoma adds Z43; it is not part of this code and both may be reported when both are documented.

  Full comparison: T85.638A vs Z43 →

• Z44— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of fitting and adjustment of external prosthetic device adds Z44; it is not part of this code and both may be reported when both are documented.

  Full comparison: T85.638A vs Z44 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

1. A 7th character applies in this family. Confirm the documented encounter matches the character assigned. See the official 7th-character definitions and this code’s variants
2. 3 Use Additional Code instructions — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
3. 22 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

• CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name T85.638A or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 2 Excludes1 notes across 2 chapters: T88.7 — Unspecified adverse effect of drug or medicament (via T85.-), Z97 — Presence of other devices (via T85.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 6 Excludes2 notes across 2 chapters: T78 — Adverse effects, not elsewhere classified (via T85.-), T79 — Certain early complications of trauma, not elsewhere classified (via T85.-), T81 — Complications of procedures, not elsewhere classified (via T85.-), T81.59 — Other complications of foreign body accidentally left in body following procedure (via T85.-), T88 — Other complications of surgical and medical care, not elsewhere classified (via T85.-), Z96 — Presence of other functional implants (via T85.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 103 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 3 MS-DRGs: DRG 919 (MDC 21), DRG 920 (MDC 21), DRG 921 (MDC 21).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):INJ037 — Complication of other surgical or medical care, injury, initial encounter (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

T85.620A — Displacement of cranial or spinal infusion catheter, initial encounter, T85.621A — Displacement of intraperitoneal dialysis catheter, initial encounter, T85.622A — Displacement of permanent sutures, initial encounter, T85.624A — Displacement of insulin pump, initial encounter, T85.625A — Displacement of other nervous system device, implant or graft, initial encounter, T85.628A — Displacement of other specified internal prosthetic devices, implants and grafts, initial encounter, T85.630A — Leakage of cranial or spinal infusion catheter, initial encounter, T85.631A — Leakage of intraperitoneal dialysis catheter, initial encounter, T85.633A — Leakage of insulin pump, initial encounter, T85.635A — Leakage of other nervous system device, implant or graft, initial encounter, T85.690A — Other mechanical complication of cranial or spinal infusion catheter, initial encounter, T85.691A — Other mechanical complication of intraperitoneal dialysis catheter, initial encounter, T85.692A — Other mechanical complication of permanent sutures, initial encounter, T85.694A — Other mechanical complication of insulin pump, initial encounter, T85.695A — Other mechanical complication of other nervous system device, implant or graft, initial encounter, T85.698A — Other mechanical complication of other specified internal prosthetic devices, implants and grafts, initial encounter, T85.71XA — Infection and inflammatory reaction due to peritoneal dialysis catheter, initial encounter, T85.72XA — Infection and inflammatory reaction due to insulin pump, initial encounter, T85.730A — Infection and inflammatory reaction due to ventricular intracranial (communicating) shunt, initial encounter, T85.731A — Infection and inflammatory reaction due to implanted electronic neurostimulator of brain, electrode (lead), initial encounter, +82 more

Same injury, other encounter phase

Same injury, coded at a different phase of treatment via the 7th character.

T85.638D — Leakage of other specified internal prosthetic devices, implants and grafts, subsequent encounterCompare T85.638A vs T85.638D →, T85.638S — Leakage of other specified internal prosthetic devices, implants and grafts, sequelaCompare T85.638A vs T85.638S →

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Complication of other surgical or medical care, injury, initial encounter).

T85.621A — Displacement of intraperitoneal dialysis catheter, initial encounter, T85.622A — Displacement of permanent sutures, initial encounter, T85.623A — Displacement of artificial skin graft and decellularized allodermis, initial encounter, T85.624A — Displacement of insulin pump, initial encounter, T85.625A — Displacement of other nervous system device, implant or graft, initial encounter, T85.628A — Displacement of other specified internal prosthetic devices, implants and grafts, initial encounter, T85.630A — Leakage of cranial or spinal infusion catheter, initial encounter, T85.631A — Leakage of intraperitoneal dialysis catheter, initial encounter, T85.633A — Leakage of insulin pump, initial encounter, T85.635A — Leakage of other nervous system device, implant or graft, initial encounter, T85.690A — Other mechanical complication of cranial or spinal infusion catheter, initial encounter, T85.691A — Other mechanical complication of intraperitoneal dialysis catheter, initial encounter, T85.692A — Other mechanical complication of permanent sutures, initial encounter, T85.693A — Other mechanical complication of artificial skin graft and decellularized allodermis, initial encounter, T85.694A — Other mechanical complication of insulin pump, initial encounter, T85.695A — Other mechanical complication of other nervous system device, implant or graft, initial encounter, T85.698A — Other mechanical complication of other specified internal prosthetic devices, implants and grafts, initial encounter, T85.71XA — Infection and inflammatory reaction due to peritoneal dialysis catheter, initial encounter, T85.72XA — Infection and inflammatory reaction due to insulin pump, initial encounter, T85.730A — Infection and inflammatory reaction due to ventricular intracranial (communicating) shunt, initial encounter, +230 more

Contextual Map

Every relationship of T85.638A in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run T85.638A with these 8 related codes in Claim Check

Hierarchy

• S00-T88 — Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) (S00-T88)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T80-T88 — Complications of surgical and medical care, not elsewhere classified[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• T88.7 — Unspecified adverse effect of drug or medicament[Excludes1](via T85.-): “specified adverse effects of drugs and medicaments (A00-R94 and T80-T88.6, T88.8)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• Z97 — Presence of other devices[Excludes1](via T85.-): “complications of internal prosthetic devices, implants and grafts (T82-T85)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Excludes2 notes

• T78 — Adverse effects, not elsewhere classified[Excludes2](via T85.-): “complications of surgical and medical care NEC (T80-T88)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• T79 — Certain early complications of trauma, not elsewhere classified[Excludes2](via T85.-): “complications occurring during or following medical procedures (T80-T88)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• T81 — Complications of procedures, not elsewhere classified[Excludes2](via T85.-): “complication of prosthetic devices, implants and grafts (T82-T85)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• T81.59 — Other complications of foreign body accidentally left in body following procedure[Excludes2](via T85.-): “obstruction or perforation due to prosthetic devices and implants intentionally left in body (T82.0-T82.5, T83.0-T83.4, T83.7, T84.0-T84.4, T85.0-T85.6)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• T88 — Other complications of surgical and medical care, not elsewhere classified[Excludes2](via T85.-): “complications of devices, implants and grafts (T82-T85)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• Z96 — Presence of other functional implants[Excludes2](via T85.-): “complications of internal prosthetic devices, implants and grafts (T82-T85)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• INJ037 — Complication of other surgical or medical care, injury, initial encounter[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
• DRG 919 — COMPLICATIONS OF TREATMENT WITH MCC[MS-DRG]: “COMPLICATIONS OF TREATMENT WITH MCC (MDC 21)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 920 — COMPLICATIONS OF TREATMENT WITH CC[MS-DRG]: “COMPLICATIONS OF TREATMENT WITH CC (MDC 21)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 921 — COMPLICATIONS OF TREATMENT WITHOUT CC/MCC[MS-DRG]: “COMPLICATIONS OF TREATMENT WITHOUT CC/MCC (MDC 21)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 21 — Injuries, Poisonings and Toxic Effects of Drugs[MDC crossing]: “Injuries, Poisonings and Toxic Effects of Drugs — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 32,029 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Complication (s) (from) (of), prosthetic device or implant, specified NEC, mechanical, leakage[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Leak, leakage, device, implant or graft, catheter NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Leak, leakage, device, implant or graft, specified NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (40)

• T85 — Complications of other internal prosthetic devices, implants and grafts[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T85.628D — Displacement of other specified internal prosthetic devices, implants and grafts, subsequent encounter[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T85.628S — Displacement of other specified internal prosthetic devices, implants and grafts, sequela[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T85.63 — Leakage of other specified internal prosthetic devices, implants and grafts[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T85.630 — Leakage of cranial or spinal infusion catheter[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T85.630A — Leakage of cranial or spinal infusion catheter, initial encounter[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T85.630D — Leakage of cranial or spinal infusion catheter, subsequent encounter[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T85.630S — Leakage of cranial or spinal infusion catheter, sequela[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 32 more

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Common coding questions

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Coding guidelines Official source data

ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to T85.638A in its code family, with their registry titles.

• T85.635 — Leakage of other nervous system device, implant or graft
• T85.635A — Leakage of other nervous system device, implant or graft, initial encounter
• T85.635D — Leakage of other nervous system device, implant or graft, subsequent encounter
• T85.635S — Leakage of other nervous system device, implant or graft, sequela
• T85.638 — Leakage of other specified internal prosthetic devices, implants and grafts
• T85.638D — Leakage of other specified internal prosthetic devices, implants and grafts, subsequent encounter
• T85.638S — Leakage of other specified internal prosthetic devices, implants and grafts, sequela
• T85.69 — Other mechanical complication of other specified internal prosthetic devices, implants and grafts
• T85.690 — Other mechanical complication of cranial or spinal infusion catheter
• T85.690A — Other mechanical complication of cranial or spinal infusion catheter, initial encounter

View all codes in the T85 family