2026 ICD-10-CM Diagnosis Code T85.43XSLeakage of breast prosthesis and implant, sequela
T85.43XS is a billable ICD-10-CM diagnosis code for leakage of breast prosthesis and implant, sequela. The 7th character S marks it as a sequela code, which reports a problem that remains after the original condition has resolved. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 922 through 923. The code is exempt from POA reporting. Coders also document this condition as complication associated with silicone gel-filled breast implant. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Complication, sequela.
Code Identity
Code Classification
Present on Admission (POA)Billing
T85.43XS is exempt from POA reporting on inpatient claims to general acute care hospitals. Review other POA exempt codes.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Complication associated with silicone gel-filled breast implant
- Leakage from breast implant
- Silicone granuloma associated with silicone gel-filled breast implant
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.
Patient EducationClinical
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Read the full article at MedlinePlus
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Convert T85.43XS to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About T85.43XSOverview
Is T85.43XS (Leakage of breast prosthesis and implant) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report leakage of breast prosthesis and implant, sequela on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What does the 7th character S in T85.43XS mean?
The final character S makes this a sequela code: it reports a lingering problem that remains after the leakage of breast prosthesis and implant itself has resolved, not the original event.
What MS-DRG does T85.43XS group to?
When leakage of breast prosthesis and implant, sequela is the principal diagnosis on an inpatient stay, it groups to MS-DRG 922, 923, with relative weights from 1.0177 to 1.7494 depending on complications. Higher weights mean higher Medicare reimbursement.
Is T85.43XS exempt from POA reporting?
Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for leakage of breast prosthesis and implant, sequela on inpatient claims.
What is the ICD-9 equivalent of T85.43XS?
Under the General Equivalence Mappings, leakage of breast prosthesis and implant, sequela converts to ICD-9-CM 909.3 (late eff surg/med compl). The mapping is approximate, so confirm the match fits the documentation.
