T85.4 vs Z45.81
T85.4 (Mechanical complication of breast prosthesis and implant) compared with Z45.81 (Encounter for adjustment or removal of breast implant), from the official CMS tabular data. Do not report these codes together: the official tabular list marks them Excludes1.
Can these codes be reported together?
No — do not report together. Z45.81 carries an Excludes1 note covering T85.4: “complications of breast implant (T85.4-)”
Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
Side by side
| T85.4Mechanical complication of breast prosthesis and implant | Z45.81Encounter for adjustment or removal of breast implant | |
|---|---|---|
| Billing status | Non-billable header Report instead: T85.41XA, T85.41XD, T85.41XS, T85.42XA, T85.42XD | Non-billable header |
| Classification | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) | Z00-Z99 — Factors Influencing Health Status and Contact with Health Services (Z00-Z99) |
| Definition | Mechanical complication of breast prosthesis and implant is a non-billable ICD-10-CM category code (T85.4). | Encounter for adjustment or removal of breast implant is a non-billable ICD-10-CM category code (Z45.81). |
| 7th character | The appropriate 7th character is to be added to each code from category T85 | — |
| Includes | — | removal or replacement of implanted device Encounter for elective implant exchange (different material) (different size) Encounter for removal of tissue expander with or without synchronous insertion of permanent implant |
| Use additional code | code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) code(s) to identify the specified condition resulting from the complication code to identify devices involved and details of circumstances (Y62-Y82) | — |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources