T85.49XA — Other mechanical complication of breast prosthesis and implant, initial encounter
Is T85.49XA billable?
Yes — T85.49XA is billable for FY2027. T85.49XA is a valid, billable ICD-10-CM code at the highest level of specificity in its branch. T85.49XA may be submitted for encounters from October 1, 2026 through September 30, 2027.
T85.49XA at a glance
| Code | T85.49XA |
|---|---|
| Description | Other mechanical complication of breast prosthesis and implant, initial encounter |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "A" | initial encounter |
What does the 7th character "A" mean in T85.49XA?
In T85.49XA, the 7th character A means initial encounter. The 7th character is required for T85.49XA to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
Which MS-DRGs does T85.49XA group to?
T85.49XA sits in MDC 09 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 600Non-Malignant Breast Disorders with CC/MCCmedical
- 601Non-Malignant Breast Disorders without CC/MCCmedical
As a secondary diagnosis, T85.49XA is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is T85.49XA listed in the Alphabetic Index?
The Alphabetic Index lists these routes under T85.49, the nearest indexed parent of T85.49XA. Use them to find the family, then select the specific code.
- Prolapse, prolapsed › breast implant
- Protrusion, protrusio › device, implant or graft › breast
- Complication › breast implant › mechanical › obstruction (s) (from) (of)
- Complication › breast implant › mechanical › perforation (s) (from) (of)
- Complication › breast implant › mechanical › protrusion (s) (from) (of)
- Complication › breast implant › mechanical › specified NEC (s) (from) (of)
- Perforation, perforated › by › device, implant or graft › breast (nontraumatic) (of)
Inclusion terms
Alternative wording in documentation that is classified to T85.49XA.
- Obstruction (mechanical) of breast prosthesis and implant
- Perforation of breast prosthesis and implant
- Protrusion of breast prosthesis and implant
Use additional code — inherited from Chapter 19
Report an additional code alongside T85.49XA to fully describe the condition. T85.49XA is sequenced first.
- code to identify any retained foreign body, if applicable (Z18.-)
Use additional code — inherited from T80-T88
Report an additional code alongside T85.49XA to fully describe the condition. T85.49XA is sequenced first.
Excludes2 — not included here — inherited from Chapter 19
The conditions below are not part of T85.49XA, but a patient may have both at the same time. When documentation supports it, T85.49XA and the excluded code may both be reported.
Excludes2 — not included here — inherited from T80-T88
The conditions below are not part of T85.49XA, but a patient may have both at the same time. When documentation supports it, T85.49XA and the excluded code may both be reported.
- any encounters with medical care for postprocedural conditions in which no complications are present, such as:
- artificial opening status (Z93.-)
- closure of external stoma (Z43.-)
- fitting and adjustment of external prosthetic device (Z44.-)
- burns and corrosions from local applications and irradiation (T20-T32)
- complications of surgical procedures during pregnancy, childbirth and the puerperium (O00-O9A)
- mechanical complication of respirator [ventilator] (J95.850)
- poisoning and toxic effects of drugs and chemicals (T36-T65 with fifth or sixth character 1-4 or 6)
- postprocedural fever (R50.82)
- specified complications classified elsewhere, such as:
- cerebrospinal fluid leak from spinal puncture (G97.0)
- colostomy malfunction (K94.0-)
- disorders of fluid and electrolyte imbalance (E86-E87)
- functional disturbances following cardiac surgery (I97.0-I97.1)
- intraoperative and postprocedural complications of specified body systems (D78.-, E36.-, E89.-, G97.3-, G97.4, H59.3-, H59.-, H95.2-, H95.3, I97.4-, I97.5, J95.6-, J95.7, K91.6-, L76.-, M96.-, N99.-)
- ostomy complications (J95.0-, K94.-, N99.5-)
- postgastric surgery syndromes (K91.1)
- postlaminectomy syndrome NEC (M96.1)
- postmastectomy lymphedema syndrome (I97.2)
- postsurgical blind-loop syndrome (K91.2)
- ventilator associated pneumonia (J95.851)
Excludes2 — not included here — inherited from T85
The conditions below are not part of T85.49XA, but a patient may have both at the same time. When documentation supports it, T85.49XA and the excluded code may both be reported.
- failure and rejection of transplanted organs and tissue (T86.-)
How long has T85.49XA existed?
T85.49XA has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.