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Home/Diagnosis/ICD-10 Coding for Breast Implant Rupture

ICD-10 Coding for Breast Implant Rupture

T85.41XA
T85.43XA

Complete ICD-10-CM coding and documentation guide for icd-10 coding for breast implant rupture includes clinical validation requirements, medical necessity guidelines, and coding policies.

Also Known as:
Implant Rupture
Breast Prosthesis Rupture
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Key Information: ICD-10 Coding for Breast Implant Rupture

Essential facts and insights about ICD-10 Coding for Breast Implant Rupture

Use ICD-10 code T85.41XA for rupture of breast implant, initial encounter, ensuring proper documentation in clinical notes.

Primary ICD-10-CM Codes

Rupture of breast implant, initial encounter

Billable Code
T85.41XA
Billable

Diagnostic Criteria

clinical_criteria:
  • • Confirmed rupture via MRI or surgery
coding_criteria:
  • • Avoid using injury codes unless trauma is confirmed

Applicable To

  • • Intracapsular rupture
  • • Extracapsular rupture

Important Notes

  • • Ensure documentation specifies rupture type and confirmation method.

Leakage of breast prosthesis, initial encounter

Billable Code
T85.43XA
Billable

Diagnostic Criteria

clinical_criteria:
  • • Use when imaging confirms leakage of silicone from the implant.

Applicable To

  • • Silicone granulomas
  • • Extracapsular silicone leakage

Important Notes

  • • Document imaging findings clearly to differentiate from rupture.
Ancillary Codes

Additional codes that may be used with this diagnosis

R07.9

Chest pain

Use if patient presents with associated chest pain.

T85.84

Capsular contracture

Use if capsular contracture is present alongside rupture.

Frequently Asked Questions

What is the ICD-10 code for breast implant rupture?

The ICD-10 code for breast implant rupture is T85.41XA, used when imaging confirms the rupture.

How is breast implant leakage coded?

Breast implant leakage is coded as T85.43XA when imaging confirms silicone leakage.

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