T85.4

T85.4: Mechanical complication of breast prosthesis and implant

Non-billable headerICD-10-CM

T85.4 is a non-billable header ICD-10-CM code for mechanical complication of breast prosthesis and implant. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.

This code requires a 7th character

The appropriate 7th character is to be added to each code from category T85

A: initial encounter
D: subsequent encounter
S: sequela

Excludes2 inherited from the categories above T85.4

Not part of this code, but both may be coded when both are present.

Written on T85: Complications of other internal prosthetic devices, implants and grafts

failure and rejection of transplanted organs and tissue (T86.-)

Other codes that can never be billed with T85.4

Their own Excludes1 notes name this code, so the conflict is not listed above.

Z44.3Encounter for fitting and adjustment of external breast prosthesis
Z45.81Encounter for adjustment or removal of breast implant

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Code history

Unchanged in every release from FY2024 to FY2027.

Code to one of these instead T85.4

5 child codes. Green means billable.