Cracking the Code

Complications from Medical or Surgical Care

If a complication from medical or surgical care initiates a visit to the doctor’s office or an admission to the hospital, a complication code is reported as the primary diagnosis. We can locate the complication codes in the T80-T88 series of the ICD-10-CM codes. When documented, the code for the specific complication is also listed. Some of the complication codes include both the nature of the complication as well as the type of procedure that caused the complication. In this case, an additional external cause code is not required.

Regarding intraoperative and postprocedural complications, these codes can be found within the body system chapters with codes specific to the organs and structures of that body system, unless the complication is specifically indexed to a T code from Chapter 19. These codes should be sequenced first, followed by a code or codes for the specific complication, if applicable.

Q: A patient was sent home with a PICC line for Vancomycin treatment at home. She returns to her physician with an infection due to the PICC Line. The infection is determined to be MRSA. What is the correct sequence and appropriate ICD-10-CM codes that are reported for this encounter?
A: T80.218A, A49.02. Rationale: When complications are documented, a code for the complication is reported first. If the cause of the complication is known, it is reported as the additional code or codes. We will look in the ICD-10-CM Alphabetic Index for Infection/due to or resulting from/central venous catheter/specified NEC T80.218-. As we verify the code in the Tabular List, it indicates this code needs a 7th character. The 7th character of “A” is reported for the initial encounter. T80.218A is correct because we do know that this is an MRSA infection, however, it is not documented whether it is a local infection or bloodstream infection. The second code selection would be for the MRSA. Looking in the ICD-10-CM alphabetical index under MRSA (Methicillin resistant Staphylococcus aureus)/infection, we are directed to A49.02. As always, we will want to verify this code selection in the Tabular List.
Reference: 2024 ICD-10-CM code book
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