T85.611S ICD-10-CM Code: Breakdown (mechanical) of intraperitoneal dialysis catheter, sequela
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FY 2026 Apr update / Injury, poisoning and certain other consequences of external causes (S00-T88) / Complications of surgical and medical care, not elsewhere classified (T80-T88)
T85.611S
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceBreakdown (mechanical) of intraperitoneal dialysis catheter, sequela
Breakdown (mechanical) of intraperitoneal dialysis catheter, sequela
CMS-HCC V28
00
RAF 0
CMS-HCC V24
MappedHCC 134
RAF 0.452
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 134
RAF 0.0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for T85.611S in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for T85.611S in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for T85.611S in this effective period.
Excludes 1
Official- mechanical complication of vascular dialysis catheter (T82.4-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for T85.611S in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for T85.611S in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for T85.611S in this effective period.
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is T85.611S an HCC code?
Yes. T85.611S maps to Dialysis Status under the V24 model but is not retained in V28.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for T85.611S
For T85.611Sto count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed T85.611S during that encounter, not just copy-forwarded from a problem list.
What This Code Means
T85.611S is the ICD-10-CM diagnosis code for breakdown (mechanical) of intraperitoneal dialysis catheter, sequela. T85.611S sits in the ICD-10-CM chapter for injury, poisoning and certain other consequences of external causes (s00-t88), within the section covering complications of surgical and medical care, not elsewhere classified (t80-t88).
Under the older CMS-HCC V24 model, T85.611S maps to Dialysis Status (HCC 134) with a community, non-dual, aged base RAF weight of 0.452. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Coders should report T85.611S only when the provider documentation supports the specific condition described, since more specific codes within the same hierarchy can capture additional clinical detail and may carry a higher RAF weight. Because T85.611S maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for T85.611S sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.