2026 ICD-10-CM Diagnosis Code T85.21XABreakdown (mechanical) of intraocular lens, initial encounter

ICD-10-CM Codes›S00–T88›T80-T88›T85

ICD-10-CM T85.21XA
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

T85.21XA is a billable ICD-10-CM diagnosis code for breakdown (mechanical) of intraocular lens, initial encounter. The 7th character A marks it as an initial encounter code, used while the patient is receiving active treatment. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 124 through 125. Coders also document this condition as breakage of prosthesis. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Complication of other surgical or medical care, injury, initial encounter.

Code Identity

ICD-10-CM Code
T85.21XA
Billable Status
Yes — Valid for Submission
Code Describes
Breakdown (mechanical) of intraocular lens, initial encounter
Short Description
Breakdown (mechanical) of intraocular lens, init encntr
Parent Code
T85.21
Breakdown (mechanical) of intraocular lens

Code Classification

ChapterS00–T88Injury, poisoning and certain other consequences of external causes
SectionT80-T88Complications of surgical and medical care, not elsewhere classified
CategoryT85Complications of other internal prosthetic devices, implants and grafts
This CodeT85.21XABreakdown (mechanical) of intraocular lens, initial encounter

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Breakage of prosthesis
  • Mechanical breakdown of intraocular lens

Coding GuidelinesGuidance

The appropriate 7th character is to be added to each code from block Complications of other internal prosthetic devices, implants and grafts (T85). Use the following options for the applicable episode of care:

  • A - initial encounter
  • D - subsequent encounter
  • S - sequela

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026, published by CMS and the National Center for Health Statistics.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR INJ037
Complication of other surgical or medical care, injury, initial encounter
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Cataract

A cataract is a clouding of the lens in your eye. It affects your vision. Cataracts are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery.

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert T85.21XA to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
996.53 Lens prosthesis malfunc
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About T85.21XAOverview

Is T85.21XA (Breakdown (mechanical) of intraocular lens) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report breakdown (mechanical) of intraocular lens, initial encounter on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What does the 7th character A in T85.21XA mean?

The final character A marks the initial encounter: use it while the patient is receiving active treatment for breakdown (mechanical) of intraocular lens, such as an emergency visit or first evaluation.

What MS-DRG does T85.21XA group to?

When breakdown (mechanical) of intraocular lens, initial encounter is the principal diagnosis on an inpatient stay, it groups to MS-DRG 124, 125, with relative weights from 0.7678 to 1.3231 depending on complications. Higher weights mean higher Medicare reimbursement.

What is the ICD-9 equivalent of T85.21XA?

Under the General Equivalence Mappings, breakdown (mechanical) of intraocular lens, initial encounter converts to ICD-9-CM 996.53 (lens prosthesis malfunc). The mapping is approximate, so confirm the match fits the documentation.