T85.43XS

T85.43XS: Leakage of breast prosthesis and implant, sequela

Billable / specific codeICD-10-CMPOA exempt

T85.43XS is a billable, specific ICD-10-CM code for leakage of breast prosthesis and implant, sequela. It is valid for submission on a claim.

Check T85.43XS with the rest of the claim: free scrubber

7th character "S": sequela

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 T85.43XS

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.-)

Risk adjustment

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

Medicare coverage

T85.43XS is named in 5 Medicare coverage policies: 5 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52849Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
A56658Billing and Coding: Cosmetic and Reconstructive Surgery
A57221Billing and Coding: Plastic Surgery
A58774Billing and Coding: Cosmetic and Reconstructive Surgery

Code history

Unchanged in every release from FY2024 to FY2027.