ICD-10 Coding for Breast Implant Complications(T85.44XA, T85.73XA)
Complete ICD-10-CM coding and documentation guide for Breast Implant Complications. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Implant Complications
T85.4Primary Range
Mechanical complications of breast prosthesis and implants
This range includes codes for mechanical complications such as rupture, leakage, and displacement of breast implants.
Infection and inflammatory reaction due to breast prosthesis and implants
This range covers infections and inflammatory reactions related to breast implants.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| T85.44XA | Capsular contracture of breast implant, initial encounter | Use when there is documented capsular contracture around a breast implant. |
|
| T85.73XA | Infection and inflammatory reaction due to breast prosthesis, initial encounter | Use when there is a documented infection related to a breast implant. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for breast implant complications
Essential facts and insights about Breast Implant Complications
Primary ICD-10-CM Codes for breast implant
Decision Criteria
clinical Criteria
- Presence of capsular contracture confirmed by clinical examination or imaging.
Applicable To
- Capsular contracture of breast prosthesis
Excludes
- Infection of breast implant (T85.73XA)
Clinical Validation Requirements
- Operative note indicating capsular contracture
- Clinical documentation of Baker Grade III/IV contracture
Code-Specific Risks
- Misidentifying the type of complication
- Incorrect sequencing with infection codes
Coding Notes
- Ensure documentation specifies the type of mechanical complication.
T85.73XA - Infection and inflammatory reaction due to breast prosthesis, initial encounter
Use when there is a documented infection related to a breast implant.
Applicable To
- Infection of breast implant
Excludes
- Mechanical complication of breast implant (T85.4-)
Clinical Validation Requirements
- Positive culture from implant pocket
- Elevated inflammatory markers (CRP, WBC)
Coding Notes
Ensure infection is clearly documented with culture results.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Breast Implant Complications to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code T85.44XA.
Impact
Clinical: Leads to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Use specific clinical terms, Document detailed findings
Impact
Reimbursement: Incorrect coding can lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use 19371 for complete capsulectomy with implant removal.
Impact
High risk of audits due to frequent coding errors.
Mitigation Strategy
Regular training on coding guidelines and documentation requirements.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Breast Implant Complications, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Breast Implant Complications
Use these documentation templates to ensure complete and accurate documentation for Breast Implant Complications. These templates include all required elements for proper coding and billing.
Breast Implant Removal with Capsulectomy
Specialty: Plastic SurgeryRequired Elements
- Pre-operative diagnosis
- Operative findings
- Procedure details
- Specimens sent for analysis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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