T85.49XS — Other mechanical complication of breast prosthesis and implant, sequela
T85.49XS is a billable, specific ICD-10-CM code for other mechanical complication of breast prosthesis and implant, sequela. It is valid for submission on a claim.
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
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
Risk adjustment
T85.49XS does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
T85.49XS is named in 5 Medicare coverage policies — 5 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- 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
Related codes at this level
Codes that share T85.49. If T85.49XS is not quite right, the correct code is usually one of these.
Questions about T85.49XS
- Is T85.49XS a billable ICD-10-CM code?
- Yes. T85.49XS is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does T85.49XS sit in the tabular list?
- Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Complications of surgical and medical care, not elsewhere classified (T80-T88).