Version 2024

2024 ICD-10-CM Diagnosis Code T86.8411

Corneal transplant failure, right eye

ICD-10-CM Code:: T86.8411
ICD-10 Code for:: Corneal transplant failure, right eye
Is Billable?: Yes - Valid for Submission
Chronic Condition Indicator: ^[1]: Chronic
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Code Information
Approximate Synonyms
Clinical Classification
Coding Guidelines
Tabular List of Diseases and Injuries
Diagnostic Related Groups Mapping
Replacement Code
Patient Education
Other Codes Used Similar Conditions
Code History

Code Classification

Injury, poisoning and certain other consequences of external causes
(S00–T88)
- Complications of surgical and medical care, not elsewhere classified
  (T80-T88)
  - Complications of transplanted organs and tissue
    (T86)

T86.8411 is a billable diagnosis code used to specify a medical diagnosis of corneal transplant failure, right eye. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

Transplant failure of cornea of right eye

Clinical Classification

Clinical Category is Complication of transplanted organs or tissue, initial encounter
CCSR Category Code: INJ036
Inpatient Default CCSR: Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.
Outpatient Default CCSR: Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.

Coding Guidelines

The appropriate 7th character is to be added to each code from block Complications of transplanted organs and tissue (T86). Use the following options for the aplicable episode of care:

A - initial encounter
D - subsequent encounter
S - sequela

T86.8411 is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
124	OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT	02	1.3219
125	OTHER DISORDERS OF THE EYE WITHOUT MCC	02	0.7975

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Replacement Code

T868411 replaces the following previously assigned ICD-10-CM code(s):

T86.841 - Corneal transplant failure

Code History

FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
FY 2021 - Code Added, effective from 10/1/2020 through 9/30/2021

Footnotes

[1] Chronic - a chronic condition code indicates a condition lasting 12 months or longer and its effect on the patient based on one or both of the following criteria:

The condition results in the need for ongoing intervention with medical products,treatment, services, and special equipment
The condition places limitations on self-care, independent living, and social interactions.