T85.49XD

T85.49XD: Other mechanical complication of breast prosthesis and implant, subsequent encounter

Billable / specific codeICD-10-CMPOA exempt

T85.49XD is a billable, specific ICD-10-CM code for other mechanical complication of breast prosthesis and implant, subsequent encounter. It is valid for submission on a claim.

Check T85.49XD with the rest of the claim: free scrubber

7th character "D": subsequent encounter

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

A: initial encounter
D: subsequent encounter
S: sequela

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Obstruction (mechanical) of breast prosthesis and implant
Perforation of breast prosthesis and implant
Protrusion of breast prosthesis and implant

Excludes2 inherited from the categories above T85.49XD

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

T85.49XD 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.