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ICD-10/T85.41XA

T85.41XA ICD-10-CM Code: Breakdown (mechanical) of breast prosthesis and implant, initial encounter

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, Appendix B.

  • MS-DRG 600 — NON-MALIGNANT BREAST DISORDERS WITH CC/MCC (MDC 09)
  • MS-DRG 601 — NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC (MDC 09)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Official Registry Overview & Definition

Breakdown (mechanical) of breast prosthesis and implant, initial encounter is a billable ICD-10-CM diagnosis code (T85.41A).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for T85.41XA in the official ICD-10-CM tabular list.

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
  • Use additional code(s) to identify the specified condition resulting from the complication
  • Use additional code to identify devices involved and details of circumstances (Y62-Y82)

Change history

No changes recorded for this code — unchanged since the FY2016 baseline of the change ledger.

Verify Before Coding

  • Billable — reportable as written.
  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim.

Contextual Map

Every relationship of T85.41XA in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

  • S00-T88 — Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) (S00-T88) [Hierarchy]
  • T80-T88 — Complications of surgical and medical care, not elsewhere classified [Hierarchy]

Referenced by Excludes1 notes

  • Z44.3 — Encounter for fitting and adjustment of external breast prosthesis [Excludes1](via T85.4.-): “complications of breast implant (T85.4-)” · check together
  • Z45.81 — Encounter for adjustment or removal of breast implant [Excludes1](via T85.4.-): “complications of breast implant (T85.4-)” · check together

Referenced by Excludes2 notes

  • N64 — Other disorders of breast [Excludes2](via T85.4.-): “mechanical complication of breast prosthesis and implant (T85.4-)” · check together

Clinical classification (CCSR)

  • INJ037 — Complication of other surgical or medical care, injury, initial encounter [CCSR]

Potential MS-DRG

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”
  • DRG 600 — NON-MALIGNANT BREAST DISORDERS WITH CC/MCC [MS-DRG]: “NON-MALIGNANT BREAST DISORDERS WITH CC/MCC (MDC 09)”
  • DRG 601 — NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC [MS-DRG]: “NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC (MDC 09)”

MDC crossing · procedures (7376)

  • MDC 09 — Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast [MDC crossing]: “Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • 0315090 — Bypass Right Axillary Artery to Right Upper Arm Artery with Autologous Venous Tissue, Open Approach [Same-MDC procedure]: “Bypass Right Axillary Artery to Right Upper Arm Artery with Autologous Venous Tissue, Open Approach — grouped in MDC 09, the procedure side of this code's crossing.” · check together
  • 031509W — Bypass Right Axillary Artery to Lower Extremity Vein with Autologous Venous Tissue, Open Approach [Same-MDC procedure]: “Bypass Right Axillary Artery to Lower Extremity Vein with Autologous Venous Tissue, Open Approach — grouped in MDC 09, the procedure side of this code's crossing.” · check together
  • 03150A0 — Bypass Right Axillary Artery to Right Upper Arm Artery with Autologous Arterial Tissue, Open Approach [Same-MDC procedure]: “Bypass Right Axillary Artery to Right Upper Arm Artery with Autologous Arterial Tissue, Open Approach — grouped in MDC 09, the procedure side of this code's crossing.” · check together
  • 03150AW — Bypass Right Axillary Artery to Lower Extremity Vein with Autologous Arterial Tissue, Open Approach [Same-MDC procedure]: “Bypass Right Axillary Artery to Lower Extremity Vein with Autologous Arterial Tissue, Open Approach — grouped in MDC 09, the procedure side of this code's crossing.” · check together
  • 03150J0 — Bypass Right Axillary Artery to Right Upper Arm Artery with Synthetic Substitute, Open Approach [Same-MDC procedure]: “Bypass Right Axillary Artery to Right Upper Arm Artery with Synthetic Substitute, Open Approach — grouped in MDC 09, the procedure side of this code's crossing.” · check together
  • and 7371 more

Nearest codes (40)

  • T85 — Complications of other internal prosthetic devices, implants and grafts [Sibling]
  • T85.321S — Displacement of prosthetic orbit of left eye, sequela [Sibling]
  • T85.328 — Displacement of other ocular prosthetic devices, implants and grafts [Sibling]
  • T85.328A — Displacement of other ocular prosthetic devices, implants and grafts, initial encounter [Sibling]
  • T85.328D — Displacement of other ocular prosthetic devices, implants and grafts, subsequent encounter [Sibling]
  • T85.328S — Displacement of other ocular prosthetic devices, implants and grafts, sequela [Sibling]
  • T85.39 — Other mechanical complication of other ocular prosthetic devices, implants and grafts [Sibling]
  • T85.390 — Other mechanical complication of prosthetic orbit of right eye [Sibling]
  • and 32 more

Referenced by Other Codes

Clinical classification (AHRQ CCSR):INJ037 — Complication of other surgical or medical care, injury, initial encounter (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Potential MS-DRG Relationships (FY2026)

CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 45 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 2 MS-DRGs: DRG 600 (MDC 09), DRG 601 (MDC 09).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Official ICD-10-CM tabular notes on other codes that name T85.41XA or its code family.

2 Excludes1 notes: Z44.3 (via T85.4.-), Z45.81 (via T85.4.-).

1 Excludes2 notes: N64 (via T85.4.-).

Frequently Asked Questions (FAQ) & Clinical Guidance

Does T85.41XA require a 7th character?

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

Nearest Codes in This Family

Official ICD-10-CM classifications closest to T85.41XA in its code family, with their registry titles.

  • T85.398A — Other mechanical complication of other ocular prosthetic devices, implants and grafts, initial encounter
  • T85.398D — Other mechanical complication of other ocular prosthetic devices, implants and grafts, subsequent encounter
  • T85.398S — Other mechanical complication of other ocular prosthetic devices, implants and grafts, sequela
  • T85.4 — Mechanical complication of breast prosthesis and implant
  • T85.41 — Breakdown (mechanical) of breast prosthesis and implant
  • T85.41XD — Breakdown (mechanical) of breast prosthesis and implant, subsequent encounter
  • T85.41XS — Breakdown (mechanical) of breast prosthesis and implant, sequela
  • T85.42 — Displacement of breast prosthesis and implant
  • T85.42XA — Displacement of breast prosthesis and implant, initial encounter
  • T85.42XD — Displacement of breast prosthesis and implant, subsequent encounter

View all codes in the T85 family