ICD code T86.831 – Bone graft failure

Key takeaways

T86.831 is a billable, six-character ICD-10-CM code for bone graft failure, with no 7th character required.

It covers failed autografts and allografts, while synthetic substitutes and devices are coded under T84.- instead.

Assign T86.831 only when the physician documents failure; rejection is T86.830, infection is T86.832, and other specified complications are T86.838.

Mechanical complications of a bone graft are coded under T84.3-, per the Excludes2 note at T86.83.

Pabau, the practice management platform we build, submits 837P claims through Claim.MD, runs eligibility checks and matches ERAs to claims.

ICD-10 Code T86.831: Quick reference for bone graft failure

ICD-10 Code T86.831 is the billable ICD-10-CM code for bone graft failure, meaning an autograft or allograft that does not incorporate into host bone. It is one of five codes under T86.83, and it is complete at six characters.

What does T86.831 cover? Clinical scope of bone graft failure

T86.831 covers a bone graft that has failed to incorporate into host bone. The graft does not unite with the surrounding bone, or it resorbs without new bone forming. This is a biological process, distinct from immune rejection.

The code applies to biologic grafts, whether autograft or allograft. Autologous cancellous bone from the iliac crest and cortical allograft from a donor both map to T86.831 when failure is documented. The tabular list does not split the code by graft source.

Clinical presentations that support T86.831 include:

• Radiographic non-union at the graft site, confirmed on X-ray or CT
• Progressive graft resorption without new bone formation
• Surgical exploration finding absent or failed incorporation
• Physician attestation of a failed graft in operative or clinical notes

What T86.831 does not cover: Immune-mediated rejection maps to T86.830, and infection at the graft site maps to T86.832. A documented complication that is none of these three maps to T86.838. Use T86.839 only when the record does not say which complication occurred.

Two kinds of failure leave subcategory T86.83 altogether. Mechanical complications of a bone graft, such as fracture or displacement, are coded under T84.3- per the Excludes2 note at T86.83. Synthetic bone substitutes and devices are not transplanted tissue, so their complications are coded under T84.- as well.

T86.831 vs the other T86.83 codes

Subcategory T86.83 holds five codes: T86.830, T86.831, T86.832, T86.838 and T86.839. The table below maps each one to its clinical trigger and the documentation it needs.

Rejection and failure split on mechanism. Rejection is immune-mediated, while failure is a breakdown in incorporation. When a chart uses both terms loosely, query the treating physician before assigning either code.

The choice runs in three steps, and the first two route the claim out of T86.83 altogether.

Where T86.831 sits in the ICD-10-CM hierarchy

The parent-child path below is what a coder cites when a payer queries the code.

• Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88)
• Block T80-T88: Complications of surgical and medical care, not elsewhere classified
• Category T86: Complications of transplanted organs and tissue
• Subcategory T86.8: Complications of other transplanted organs and tissue
• Group T86.83: Complications of bone graft
• Code T86.831: Bone graft failure (this code)

Chapter 19 placement tells the payer that the encounter concerns a complication of earlier surgical care. That context carries into the medical necessity review of any revision procedure.

Documentation requirements for T86.831

The ICD-10-CM Official Guidelines for Coding and Reporting require the physician’s documentation to support the assigned code. For T86.831, the minimum record elements are:

1. Physician attestation of failure: The operative report, clinic note or radiology interpretation must describe graft failure, such as “failed graft,” “non-union” or “failed incorporation.” Coders may not infer failure from imaging alone without physician correlation.
2. Date and type of original graft procedure: The record must show when the original graft was placed. It must also say whether it was an autograft or an allograft.
3. Imaging evidence: An X-ray or CT report describing non-union or resorption at the graft site supports the code. A radiology report without physician correlation is not sufficient on its own.
4. Encounter context: The visit must relate to managing or evaluating the failed graft. Do not assign T86.831 at a routine post-op follow-up unless failure is the documented reason for the encounter.

Encounter type and 7th character extensions

T86.831 is complete at six characters. No 7th character extension table applies to this code. The initial/subsequent/sequela encounter logic that governs many Chapter 19 injury codes does not add a character to T86.831 itself.

Encounter type still matters for the claim. A first workup, ongoing management and a late effect each belong in the encounter documentation. The code itself stays the same. Your medical billing workflow must capture that visit context in the chart, because medical necessity review reads it.

CPT codes commonly paired with T86.831

T86.831 is a diagnosis code, so it always appears alongside a procedure code on a claim. The most frequent pairings are revision or replacement grafting after a documented failure.

Payers running edit checks flag T86.831 when it appears without a clinically appropriate procedure code. Confirm the procedure-to-diagnosis pairing in the chart before the claim goes out.

Payer requirements and prior authorization for T86.831 claims

Prior authorization rules for revision bone graft surgery vary by payer and plan. Medicare does not require prior authorization for most orthopedic revision procedures, but commercial and Medicare Advantage plans often do. Submitting T86.831 without confirming authorization status is an avoidable denial cause.

• Medicare: Review any Local Coverage Determination (LCD) that applies to the procedure in your jurisdiction. Coverage criteria change, so check the current effective date before the procedure.
• Medicare Advantage: Plans may require prior authorization for revision graft surgery even when traditional Medicare does not. Confirm with the specific plan.
• Commercial insurers: Most require a letter of medical necessity citing the failed graft documentation. That means the imaging report, the operative note from the original graft and the physician’s attestation of failure.
• Medicaid: State Medicaid programs set their own prior authorization rules, and requirements differ materially between states.

Run a prior authorization check for the revision procedure code during insurance eligibility verification. Catching a missing authorization before surgery avoids a larger denial afterward. Practices that bill electronically can run eligibility checks through Claim.MD, which connects to thousands of US payers. Where a payer requires enrollment, Pabau surfaces Claim.MD’s enrollment forms.

Common claim denial reasons for T86.831 and how to prevent them

Claims carrying T86.831 are denied for predictable reasons, and each one has a specific prevention step. Our denial code reference explains the CARC and RARC codes a payer returns.

When a T86.831 claim is denied, start the denial management review by checking which T86.83 code the documentation supports. Then fix the physician query process upstream. Claim.MD returns 835 electronic remittance advice files, and Pabau matches each one to its claim. The CARC denial reason then shows in the patient’s billing record, with no manual payer portal lookup.

Autograft vs allograft failure: Does graft source affect T86.831 coding?

No. T86.831 covers failure of either biologic graft type, autograft or allograft. The tabular list does not subdivide the code by source, so the code is the same either way.

Document the graft source in the chart anyway, because it informs the revision plan and may affect payer coverage criteria. It does not change the ICD-10-CM code selection.

How Pabau supports bone graft failure claims

A T86.831 claim depends on work done before it is filed. The revision needs prior authorization, the patient’s coverage needs checking, and any denial needs reading against the chart.

In Pabau, the practice records the authorization code, dates and sessions on the patient’s case, with a warning when one is missing. Pabau’s claims software for practices submits 837P claims through Claim.MD, runs eligibility checks and matches ERAs to claims.

The revision claim goes out with its authorization on file. If it is denied, your billers can trace the denial to a specific CARC code.

Get bone graft revision claims out cleaner

Pabau’s claims management submits 837P claims through Claim.MD, runs eligibility checks and matches ERAs to claims. Authorization codes sit on the patient’s case, with a warning when one is missing.

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Conclusion

T86.831 is right only when the physician has documented failure, as distinct from rejection, infection or a mechanical complication. The five T86.83 codes sit close together, and a short physician query costs far less than a denial cycle.

Build that check into the workflow before the claim is built. Confirm the graft was an autograft or allograft, rule out a T84.3- mechanical complication, then match the documented mechanism to its code.

Book a demo to see how Pabau keeps authorizations, eligibility checks and remittances for revision claims on one patient record.

Continue your research

Need to understand how claims move through a clearinghouse? Medical claims clearinghouse guide explains how 837P files are validated and routed to payers.

Building a denial resolution process for complication codes? Denial codes in medical billing covers CARC and RARC code interpretation for appeal workflows.

Want to understand the 837 file format before integrating with a clearinghouse? 837 file overview breaks down the electronic claim transaction structure.

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