The following ICD-10-CM codes support medical necessity and provide coverage for (CPT) codes: 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, and 19396 for Reconstructive Breast Surgery: Removal of Breast Implants.
CPT® 11970 is the correct code for this procedure. “Attention was turned to the left breast where the patient had an oncologic mastectomy for breast cancer. The lateral portion of the previous scar was incised with a #15 blade and an ellipse of the tissue was passed off the field.
Primarily performed to treat or prevent breast cancer, mastectomy is normally carried out to remove existing cancerous cells within the breast and thereby reduce the potential for breast cancer to spread.
Immediately after a patient’s mastectomy, a reconstructive surgeon will evaluate the skin flaps and prepare to insert a tissue expander. Following placement of the expander, the patient will present for subsequent fills of saline until the breast has expanded to the patient’s liking.
Acquired absence of right breast and nipple Z90. 11 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z90. 11 became effective on October 1, 2021.
"Z90. 11 - Acquired Absence of Right Breast and Nipple." ICD-10-CM, 10th ed., Centers for Medicare and Medicaid Services and the National Center for Health Statistics, 2018.
Z42. 1 - Encounter for breast reconstruction following mastectomy. ICD-10-CM.
ICD-10 Code for Breast implant status- Z98. 82- Codify by AAPC.
The breast surgery Current Procedural Terminology (CPT) codes were developed when axillary dissection was standard therapy for breast cancer. Modified radical mastectomy is coded 19307; lumpectomy with axillary dissection is coded 19302.
Breast Cancer ICD-10 Code Reference SheetPERSONAL OR FAMILY HISTORY*Z85.3Personal history of malignant neoplasm of breastZ80.3Family history of malignant neoplasm of breast
How do surgeons use implants to reconstruct a woman's breast? Implants are inserted underneath the skin or chest muscle following the mastectomy. (Most mastectomies are performed using a technique called skin-sparing mastectomy, in which much of the breast skin is saved for use in reconstructing the breast.)
A simple mastectomy (left) removes the breast tissue, nipple, areola and skin but not all the lymph nodes. A modified radical mastectomy (right) removes the entire breast — including the breast tissue, skin, areola and nipple — and most of the underarm (axillary) lymph nodes.
Report code 19303, Mastectomy, simple, complete, for the mastectomy.
For example, Z12. 31 (Encounter for screening mammogram for malignant neoplasm of breast) is the correct code to use when you are ordering a routine mammogram for a patient. However, coders are coming across many routine mammogram orders that use Z12.
ICD-10-CM Code for Encounter for adjustment or removal of breast implant Z45. 81.
The new notes under the codes advise coding professionals to report 19342 for removal and replacement with new implant. A quick glance of the code description for 19342 reveals that this is for insertion or replacement of breast implant on separate day from mastectomy.
Report code 19303, Mastectomy, simple, complete, for the mastectomy.
CPT 19380 is used when a revision is made to an already reconstructed breast that includes significant removal of tissue; re-ad- vancement and/or re-inset of flaps in autol- ogous reconstruction; or significant capsular revisions combined with soft-tissue excision in implant-based reconstruction.
Definition: Tumors or cancer of the human BREAST.
17340 Cryotherapy for acne 17360 Chemical exfoliation 17380 Electrolysis 69300 Otoplasty . 9. Punch graft hair transplant (CPT 15775- 15776)
Medicare reimbursement articles. CPT code 90649, 90650, 90651; Patient has WC and Medicare insurance? which insurance is primary. CPT 91311, 0111A, 0112A – Covid Vaccine for children
procedure codes and description group 1 paragraph: n/a group 1 codes: 11920 tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less. 11921 tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm
Article Text. The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD DL39051 Cosmetic and Reconstructive Surgery.
Article Text. The following coding and billing guidance is to be used with its associated Local coverage determination. Cosmetic surgery is performed to reshape normal structures of the body, for the purpose of improving the patient’s appearance and self-esteem.
Panniculectomy and Body Contouring Procedures Page 2 of 6 UnitedHealthcare Commercial Coverage Determination Guideline Effective 10/01/2021
The following ICD-10-CM codes support medical necessity and provide coverage for (CPT) code: 19318 for reduction mammaplasty and gigantomastia of pregnancy.
The following ICD-10-CM codes support medical necessity and provide coverage for (CPT) codes: 15830, 15847, and 15877 for Abdominal Lipectomy/ Panniculectomy.
Documentation supporting that gynecomastia persists after 3 to 4 months of unsuccessful medical treatment, the use of potential gynecomastia-inducing drugs and substances has been ruled out and gynecomastia persists for at least one year.
Note: Dual diagnosis reporting is required to support the service as medically reasonable and necessary. ICD-10 diagnosis codes L98.7 or M79.3 should be reported as the primary diagnosis with ICD-10 codes L30.4, R26.2, or Z74.09 reported as the secondary diagnosis.
The medical record must include a description of the condition requiring the rhinoplasty.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.
Glandular breast tissue confirming true gynecomastia is documented on physical exam and/or mammography.
The following ICD-10-CM codes support medical necessity and provide coverage for (CPT) code: 19318 for reduction mammaplasty and gigantomastia of pregnancy.
The following ICD-10-CM codes support medical necessity and provide coverage for (CPT) codes: 15830, 15847, and 15877 for Abdominal Lipectomy/ Panniculectomy.
Documentation supporting that gynecomastia persists after 3 to 4 months of unsuccessful medical treatment, the use of potential gynecomastia-inducing drugs and substances has been ruled out and gynecomastia persists for at least one year.
Note: Dual diagnosis reporting is required to support the service as medically reasonable and necessary. ICD-10 diagnosis codes L98.7 or M79.3 should be reported as the primary diagnosis with ICD-10 codes L30.4, R26.2, or Z74.09 reported as the secondary diagnosis.
The medical record must include a description of the condition requiring the rhinoplasty.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.
Glandular breast tissue confirming true gynecomastia is documented on physical exam and/or mammography.
Immediately after a patient’s mastectomy, a reconstructive surgeon will evaluate the skin flaps and prepare to insert a tissue expander. Following placement of the expander, the patient will present for subsequent fills of saline until the breast has expanded to the patient’s liking.
In this case, the physician removed the tissue expander and exchanged it for an implant in a straightforward fashion, without any extra work done to the breast or the capsule. CPT® 11970 is the correct code for this procedure.
CPT code 11970 alone does not account for this additional work, which is over and above removal of an expander and replacement with a permanent implant. The provider should document if the capsule was particularly thick or tight to support the extra effort involved for billing the higher service.
Because nipple tattooing is calculated based on the total size of the areas, this is coded as 11921 and 11922. Because many payers reimburse breast reconstruction services only in relation to breast cancer, it’s prudent for providers to document current or past history of breast cancer in the operative report.
Code 19342 would be appropriate due to the extra amount of work involved with the surgery.
For example, the patient has bilateral tissue expanders with dermal matrix placed on May 1. This surgery is coded 19357-50 and 15777-50. The patient presents for her first fill on June 1, and has subsequent fills on June 17, June 30, and July 19. On Aug. 5 the patient returns again. This service is outside of the 90 day global period for the tissue expander insertion. During her visit for the fill, the physician completes a problem focused history and exam with straightforward medical decision-making. This visit is billed as 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making.
CPT® 19357 Breast reconstruction, immediate or delayed , with tissue expander, including subsequent expansion describes this first stage. The use of a dermal matrix, such as AlloDerm®, facilitates a higher initial expansion and is additionally billable with add-on code +15777 Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (eg, breast, trunk) (List separately in addition to code for primary procedure).
Z42.1 is a valid billable ICD-10 diagnosis code for Encounter for breast reconstruction following mastectomy . It is found in the 2021 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2020 - Sep 30, 2021 .
DO NOT include the decimal point when electronically filing claims as it may be rejected. Some clearinghouses may remove it for you but to avoid having a rejected claim due to an invalid ICD-10 code, do not include the decimal point when submitting claims electronically. See also:
The following ICD-10-CM codes support medical necessity and provide coverage for (CPT) code: 19318 for reduction mammaplasty and gigantomastia of pregnancy.
The following ICD-10-CM codes support medical necessity and provide coverage for (CPT) codes: 15830, 15847, and 15877 for Abdominal Lipectomy/ Panniculectomy.
Documentation supporting that gynecomastia persists after 3 to 4 months of unsuccessful medical treatment, the use of potential gynecomastia-inducing drugs and substances has been ruled out and gynecomastia persists for at least one year.
Note: Dual diagnosis reporting is required to support the service as medically reasonable and necessary. ICD-10 diagnosis codes L98.7 or M79.3 should be reported as the primary diagnosis with ICD-10 codes L30.4, R26.2, or Z74.09 reported as the secondary diagnosis.
The medical record must include a description of the condition requiring the rhinoplasty.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.
Glandular breast tissue confirming true gynecomastia is documented on physical exam and/or mammography.