Version 2024

2024 ICD-10-CM Diagnosis Code T88.9XXS

Complication of surgical and medical care, unspecified, sequela

ICD-10-CM Code:: T88.9XXS
ICD-10 Code for:: Complication of surgical and medical care, unsp, sequela
Is Billable?: Yes - Valid for Submission
Chronic Condition Indicator: ^[1]: Not chronic
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Code Information
Approximate Synonyms
Clinical Classification
Coding Guidelines
Tabular List of Diseases and Injuries
Diagnostic Related Groups Mapping
Present on Admission (POA)
Convert to ICD-9 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)
  - Other complications of surgical and medical care, not elsewhere classified
    (T88)

T88.9XXS is a billable diagnosis code used to specify a medical diagnosis of complication of surgical and medical care, unspecified, sequela. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

T88.9XXS is a sequela code, includes a 7th character and should be used for complications that arise as a direct result of a condition like complication of surgical and medical care unspecified. According to ICD-10-CM Guidelines a "sequela" code should be used for chronic or residual conditions that are complications of an initial acute disease, illness or injury. The most common sequela is pain. Usually, two diagnosis codes are needed when reporting sequela. The first code describes the nature of the sequela while the second code describes the sequela or late effect.

Unspecified diagnosis codes like T88.9XXS are acceptable when clinical information is unknown or not available about a particular condition. Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient's condition. Specific diagnosis codes should not be used if not supported by the patient's medical record.

Approximate Synonyms

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

Accident during hyperbaric treatment
Accidental wound in surgical operation
Adverse event following complementary therapy
Adverse reaction to UVB light phototherapy
Complication of electroshock therapy
Complication of health care
Complication of health care
Complication of medical care
Complication of medical care
Complication of preventive medicine procedure
Electroshock therapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at the time of procedure
Hepatic failure as a complication of care
Iatrogenic disorder
Iatrogenic tattoo
Injury as a result of positioning
Late effect of medical and surgical care complication
Perioperative injury
Perioperative positioning injury
Respiratory complications of care
Severe medical complication
Shock therapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at the time of procedure
Tattoo of skin
Vascular complication of medical care
Voice disorder due to iatrogenic factor

Clinical Classification

Clinical Category is Complication, sequela
CCSR Category Code: INJ076
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 Other complications of surgical and medical care, not elsewhere classified (T88). Use the following options for the aplicable episode of care:

A - initial encounter
D - subsequent encounter
S - sequela

T88.9XXS 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
922	OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC	21	1.7449
923	OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC	21	1.0114

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.

Present on Admission (POA)

T88.9XXS is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here.

CMS POA Indicator Options and Definitions

POA Indicator	Reason for Code	CMS will pay the CC/MCC DRG?
Y	Diagnosis was present at time of inpatient admission.	YES
N	Diagnosis was not present at time of inpatient admission.	NO
U	Documentation insufficient to determine if the condition was present at the time of inpatient admission.	NO
W	Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.	YES
1	Unreported/Not used - Exempt from POA reporting.	NO

Convert T88.9XXS to ICD-9-CM

ICD-9-CM Code: 909.3 - Late eff surg/med compl
Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.

Other ICD-10-CM Codes Commonly Used for Similar Conditions

Filter related codes list:

T88 Other complications of surgical and medical care, not elsewhere classified.
T88.0 Infection following immunization.
T88.0XXA Infection following immunization, initial encounter.
T88.0XXD Infection following immunization, subsequent encounter.
T88.0XXS Infection following immunization, sequela.
T88.1 Other complications following immunization, not elsewhere classified.
T88.1XXA Other complications following immunization, not elsewhere classified, initial encounter.
T88.1XXD Other complications following immunization, not elsewhere classified, subsequent encounter.
T88.1XXS Other complications following immunization, not elsewhere classified, sequela.
T88.2 Shock due to anesthesia.
T88.2XXA Shock due to anesthesia, initial encounter.
T88.2XXD Shock due to anesthesia, subsequent encounter.
T88.2XXS Shock due to anesthesia, sequela.
T88.3 Malignant hyperthermia due to anesthesia.
T88.3XXA Malignant hyperthermia due to anesthesia, initial encounter.
T88.3XXD Malignant hyperthermia due to anesthesia, subsequent encounter.
T88.3XXS Malignant hyperthermia due to anesthesia, sequela.
T88.4 Failed or difficult intubation.
T88.4XXA Failed or difficult intubation, initial encounter.
T88.4XXD Failed or difficult intubation, subsequent encounter.
T88.4XXS Failed or difficult intubation, sequela.
T88.5 Other complications of anesthesia.
T88.51 Hypothermia following anesthesia.
T88.51XA Hypothermia following anesthesia, initial encounter.
T88.51XD Hypothermia following anesthesia, subsequent encounter.
T88.51XS Hypothermia following anesthesia, sequela.
T88.52 Failed moderate sedation during procedure.
T88.52XA Failed moderate sedation during procedure, initial encounter.
T88.52XD Failed moderate sedation during procedure, subsequent encounter.
T88.52XS Failed moderate sedation during procedure, sequela.
T88.53 Unintended awareness under general anesthesia during procedure.
T88.53XA Unintended awareness under general anesthesia during procedure, initial encounter.
T88.53XD Unintended awareness under general anesthesia during procedure, subsequent encounter.
T88.53XS Unintended awareness under general anesthesia during procedure, sequela.
T88.59 Other complications of anesthesia.
T88.59XA Other complications of anesthesia, initial encounter.
T88.59XD Other complications of anesthesia, subsequent encounter.
T88.59XS Other complications of anesthesia, sequela.
T88.6 Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered.
T88.6XXA Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter.
T88.6XXD Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, subsequent encounter.
T88.6XXS Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, sequela.
T88.7 Unspecified adverse effect of drug or medicament.
T88.7XXA Unspecified adverse effect of drug or medicament, initial encounter.
T88.7XXD Unspecified adverse effect of drug or medicament, subsequent encounter.
T88.7XXS Unspecified adverse effect of drug or medicament, sequela.
T88.8 Other specified complications of surgical and medical care, not elsewhere classified.
T88.8XXA Other specified complications of surgical and medical care, not elsewhere classified, initial encounter.
T88.8XXD Other specified complications of surgical and medical care, not elsewhere classified, subsequent encounter.
T88.8XXS Other specified complications of surgical and medical care, not elsewhere classified, sequela.
T88.9 Complication of surgical and medical care, unspecified.

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 - No Change, effective from 10/1/2020 through 9/30/2021
FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.

Footnotes

[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.