2026 ICD-10-CM Diagnosis Code T85.49XSOther mechanical complication of breast prosthesis and implant, sequela
T85.49XS is a billable ICD-10-CM diagnosis code for other mechanical complication 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 breakage of prosthesis. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Complication, sequela.
Code Identity
Code Classification
Present on Admission (POA)Billing
T85.49XS 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.
- Breakage of prosthesis
- Pain associated with breast implant
- Pain associated with internal prosthetic device
- Protrusion of prosthetic breast implant
- Rippling of surface of breast associated with prosthetic breast implant
- Rupture of breast implant
- Rupture of left breast implant
- Rupture of right 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
Breast Reconstruction
If you need a mastectomy, you have a choice about whether or not to have surgery to rebuild the shape of the breast. Instead of breast reconstruction, you could choose to wear a breast form that replaces the breast, wear padding inside your bra, or do nothing. All of these options have pros and cons.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert T85.49XS to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About T85.49XSOverview
Is T85.49XS a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report other mechanical complication 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 T85.49XS mean?
The final character S makes this a sequela code: it reports a lingering problem that remains after the other mechanical complication of breast prosthesis and implant itself has resolved, not the original event.
What MS-DRG does T85.49XS group to?
When other mechanical complication 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 T85.49XS 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 other mechanical complication of breast prosthesis and implant, sequela on inpatient claims.
What is the ICD-9 equivalent of T85.49XS?
Under the General Equivalence Mappings, other mechanical complication 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.
