2027 ICD-10-CM Diagnosis Code T81.49XSInfection following a procedure, other surgical site, sequela

ICD-10-CM Codes›S00–T88›T80-T88›T81

ICD-10-CM T81.49XS
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

T81.49XS is a billable ICD-10-CM diagnosis code for infection following a procedure, other surgical site, sequela. The 7th character S marks it as a sequela code, which reports a problem that remains after the original condition has resolved. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 922 through 923. The code is exempt from POA reporting. Coders also document this condition as methicillin resistant Staphylococcus aureus infection. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Complication, sequela.

Code Identity

ICD-10-CM Code
T81.49XS
Billable Status
Yes — Valid for Submission
Code Describes
Infection following a procedure, other surgical site, sequela
Short Description
Infection fol a procedure, other surgical site, sequela
Parent Code
T81.49
Infection following a procedure, other surgical site

Code Classification

ChapterS00–T88Injury, poisoning and certain other consequences of external causes
SectionT80-T88Complications of surgical and medical care, not elsewhere classified
CategoryT81Complications of procedures, not elsewhere classified
This CodeT81.49XSInfection following a procedure, other surgical site, sequela

Present on Admission (POA)Billing

T81.49XS is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Complications of surgical and medical care, not elsewhere classified (T80-T88).

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Methicillin resistant Staphylococcus aureus infection
  • MRSA infection of postoperative wound
  • Postoperative wound abscess
  • Postoperative wound infection
  • Stitch infection
  • Surgical site infection
  • Wound abscess
  • Wound abscess following procedure

Coding GuidelinesGuidance

The appropriate 7th character is to be added to each code from block Complications of procedures, not elsewhere classified (T81). Use the following options for the applicable episode of care:

  • A - initial encounter
  • D - subsequent encounter
  • S - sequela

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, published by CMS and the National Center for Health Statistics.

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to T81.49XS: its own notes plus those printed at T81.4, T81, block T80-T88, and Chapter 19. A note printed at a category, block or chapter applies to every code under it.

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From T81.4 Infection following a procedure applies to 18 codes
  • 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)
From T81 Complications of procedures, not elsewhere classified applies to 240 codes
From Block T80-T88 Complications of surgical and medical care, not elsewhere classified applies to 1,683 codes
  • 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)
From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes

Use Additional Code

Add a second code, after this one, to fully describe the condition.

From T81.4 Infection following a procedure applies to 18 codes
  • code to identify infection
  • code (R65.2-) to identify severe sepsis, if applicable
From T81 Complications of procedures, not elsewhere classified applies to 240 codes
  • code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
From Block T80-T88 Complications of surgical and medical care, not elsewhere classified applies to 1,683 codes
  • 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)
From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes
  • code to identify any retained foreign body, if applicable (Z18.-)

Code Also

A second code may be needed to fully describe the condition; the note gives no sequencing direction.

From T81.4 Infection following a procedure applies to 18 codes
  • if applicable, disruption of internal operation (surgical) wound (T81.32-)

Notes

General instructions on how these codes are used.

From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes
  • Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code
  • The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes.

7th Character

Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.

From T81 Complications of procedures, not elsewhere classified applies to 240 codes
  • The appropriate 7th character is to be added to each code from category T81
Values for category T81 Encounter: Initial, Subsequent, Sequela
  • Ainitial encounter
  • Dsubsequent encounter
  • Ssequela this code

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name T81.49XS, its category, or a range that includes it.

Excludes1 2

These codes carry an Excludes1 note naming T81.49XS: they are not reported together with it, unless the two conditions are unrelated.

  • O86.0 Infection of obstetric surgical wound
    complications of procedures, not elsewhere classified (T81.4-) names T81.4-, which includes this code
  • R50.82 Postprocedural fever
    postprocedural infection (T81.4-) names T81.4-, which includes this code

Excludes2 3

These codes carry an Excludes2 note naming T81.49XS: its condition is not part of those codes, and both may be reported when the patient has both.

  • K68.11 Postprocedural retroperitoneal abscess
    infection following procedure (T81.4-) names T81.4-, which includes this code
  • T80.2 Infections following infusion, transfusion and therapeutic injection
    postprocedural infections (T81.4-) names T81.4-, which includes this code
  • T88 Other complications of surgical and medical care, not elsewhere classified
    complication following procedure NEC (T81.-) names T81.-, which includes this code

Code First 2

These codes say to code first a condition named in the note, and T81.49XS is one of the conditions named.

  • J98.51 Mediastinitis
    underlying condition, if applicable, such as postoperative mediastinitis (T81.-) names T81.-, which includes this code
  • R65.2 Severe sepsis
    infection following a procedure (T81.4-) names T81.4-, which includes this code

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR INJ076
Complication, sequela
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

After Surgery

After any operation, you'll have some side effects. There is usually some pain with surgery. There may also be swelling and soreness around the area that the surgeon cut. Your surgeon can tell you which side effects to expect.

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Code History & ChangesHistory

Replacement T81.49XS replaces the following previously assigned code(s):

  • T81.4XXS - Infection following a procedure, sequela
FY 2019AddedAdded to the ICD-10-CM code setEffective October 1, 2018.
FY 2020–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About T81.49XSOverview

What is the ICD-10 code for infection following a procedure, other surgical site, sequela?

The ICD-10-CM code for infection following a procedure, other surgical site, sequela is T81.49XS (sometimes written as T8149XS). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is T81.49XS (Infection following a procedure, other surgical site) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report infection following a procedure, other surgical site, sequela on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What does the 7th character S in T81.49XS mean?

The final character S makes this a sequela code: it reports a lingering problem that remains after the infection following a procedure, other surgical site itself has resolved, not the original event.

What MS-DRG does T81.49XS group to?

When infection following a procedure, other surgical site, sequela is the principal diagnosis on an inpatient stay, it groups to MS-DRG 923, 922, with relative weights from 0.9980 to 1.6248 depending on complications. Higher weights mean higher Medicare reimbursement.

Is T81.49XS exempt from POA reporting?

Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for infection following a procedure, other surgical site, sequela on inpatient claims. The code appears in the Complications of surgical and medical care, not elsewhere classified (T80-T88) range of the CMS exempt list.