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ICD-10-CM 2027 diagnosis code

T85.43XALeakage of breast prosthesis and implant, initial encounter

✓ Billable / specificRequires 7th characterCC — complication/comorbidity

T85.43XA is a valid, billable ICD-10-CM code for leakage of breast prosthesis and implant, initial encounter. It can be reported on claims for dates of service from October 1, 2026 – September 30, 2027.

Code unchanged since ICD-10-CM took effect on October 1, 2015. Source: official FY2027 ICD-10-CM release from CDC/NCHS and CMS. Page updated September 29, 2026. About our data

About T85.43XA

T85.43XA is the ICD-10-CM diagnosis code for leakage of breast prosthesis and implant, initial encounter. It belongs to category T85 (complications of other internal prosthetic devices, implants and grafts), block T80-T88 (complications of surgical and medical care, not elsewhere classified) and chapter 19 (injury, poisoning and certain other consequences of external causes). It is billable, so it can be reported on its own for dates of service from October 1, 2026 through September 30, 2027.

The 7th character "A" means initial encounter: use it while the patient is receiving active treatment for the condition.

As a secondary diagnosis it is a CC (complication or comorbidity), which can move an inpatient stay into the "with CC" MS-DRG of its family, unless the principal diagnosis excludes it.

In MS-DRG v44.0, it is part of the grouping logic for DRG 600 (Non-Malignant Breast Disorders with CC/MCC, relative weight 0.9975) and DRG 601 (Non-Malignant Breast Disorders without CC/MCC, relative weight 0.6017), in MDC 09 (Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast), as a principal or secondary diagnosis. The DRG a claim lands in depends on the principal diagnosis, procedures and any CC/MCC secondary diagnoses.

It has been part of ICD-10-CM since the code set took effect on October 1, 2015 and hasn't changed since.

Before ICD-10, this condition was coded in ICD-9-CM as 996.54 (mechanical complication due to breast prosthesis).

7th character

Ainitial encounter

CC/MCC status for this injury by encounter: CC for A; Neither CC nor MCC for D, S.

Other encounter types for T85.43:

Notes that apply from higher levels

Instructions written at a parent level also apply to T85.43XA.

› From T85 Complications of other internal prosthetic devices, implants and grafts
Excludes2
  • failure and rejection of transplanted organs and tissue (T86.-)

Broader instructions also apply from T80-T88 Complications of surgical and medical care, not elsewhere classified and Chapter 19: Injury, poisoning and certain other consequences of external causes.

MS-DRG v44.0 grouping

All DRGs →

Inpatient MS-DRGs this diagnosis can group to, as the principal or a secondary diagnosis, depending on the rest of the claim.

MDC 09 · Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast

ICD-9-CM equivalent

Converter →
  • 996.54Mechanical complication due to breast prosthesisapproximate

From the CMS 2018 General Equivalence Mappings (GEMs), the final GEMs release.

Code history

  1. 2016
  2. 2017
  3. 2018
  4. 2019
  5. 2020
  6. 2021
  7. 2022
  8. 2023
  9. 2024
  10. 2025
  11. 2026
  12. 2027
  • FY2016 (effective 10/1/2015): Added (first year of ICD-10-CM)
  • No changes since FY2016.

Common questions about T85.43XA

Is T85.43XA billable?

Yes. T85.43XA is a billable/specific ICD-10-CM code valid for FY2027 (October 1, 2026 – September 30, 2027).

What does the "A" at the end of T85.43XA mean?

It is the 7th character for initial encounter. Per the official guidelines, use it while the patient is receiving active treatment for the condition.

Can T85.43XA be used as a principal diagnosis?

Yes. The Medicare Code Editor doesn't restrict T85.43XA as a principal diagnosis.

Is T85.43XA a CC or MCC?

T85.43XA is a CC (complication or comorbidity) under MS-DRG v44.0, unless excluded by the principal diagnosis.

What DRG does T85.43XA group to?

T85.43XA is used in the MS-DRG v44.0 logic for MS-DRG 600 (Non-Malignant Breast Disorders with CC/MCC) and MS-DRG 601 (Non-Malignant Breast Disorders without CC/MCC). Which one applies depends on whether it is the principal diagnosis and on the rest of the claim.

What is the ICD-9 code for T85.43XA?

The CMS General Equivalence Mappings map T85.43XA to ICD-9-CM 996.54.