icd 10 code for mastectomy with reconstruction

Does insurance cover breast reconstruction after a mastectomy?

Under the WHCRA, group health plans, insurance companies, and HMOs that offer mastectomy coverage must also provide coverage for reconstructive surgery after mastectomy. This coverage includes reconstruction of the breast removed by mastectomy, reconstruction of the other breast to give a more balanced look, breast prostheses, and treatment of physical complications at all stages of the mastectomy, including lymphedema.

What to expect during and after mastectomy surgery?

• Problems with the anesthesia
• Bleeding
• Blood clots
• Fluid build-up in the breast or the donor site (for a tissue flap), with swelling and pain
• Infection at the surgery site (s)
• Wound healing problems
• Extreme tiredness ( fatigue)

What do breast implants look like after a mastectomy?

Your individual results will depend on factors, such as:

• Your natural breast tissue before and after mastectomy
• Your unique body shape
• Your lifestyle, which can affect the type of reconstruction that is best for you
• Type of mastectomy performed
• Choice of breast implants or natural tissue reconstruction
• Reconstructive breast surgery technique

Is it possible to have breast implants after breast reduction?

After breast reduction surgery, most patients are satisfied with their results. Some women, however, opt to have breast augmentation years later to restore lost volume, primarily due to weight loss and postpartum changes, as opposed to breast augmentation after birth. It is common for breast shape and overall aesthetic changes to be made at the ...

What is the ICD 10 code for breast reconstruction following mastectomy?

1 for Encounter for breast reconstruction following mastectomy is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .

What is the ICD 10 code for double mastectomy?

Acquired absence of bilateral breasts and nipples The 2022 edition of ICD-10-CM Z90. 13 became effective on October 1, 2021.

How do you code breast reconstruction?

Code 19380 [Revision of reconstructed breast] is a non-specific code intended to capture revisional procedures other than capsulotomies and capsulectomies. As the code descriptor states, in order to report 19380, the procedures must be performed on a breast that has already been reconstructed.

What is the difference between a simple and radical mastectomy?

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.

What is the ICD-10 code for mastectomy?

Encounter for breast reconstruction following mastectomy Z42. 1 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 Z42. 1 became effective on October 1, 2021.

How do you code a bilateral mastectomy?

Report a “1” in the number-of-services field. For example, if you are billing for a bilateral mastectomy, you would report CPT code 19303 (Mastectomy, simple, complete) with the modifier. You would report the service as a single line item: 19303 50.

What is the difference between CPT code 19370 and 19371?

A CPT Assistant newsletter states “A capsulectomy (CPT code 19371) involves removal of the capsule. The implant is also removed and may or may not be replaced.” Therefore, CPT 19370 (capsulotomy) is included in 19328 when performed to remove the implant.

Can 11970 and 19370 be billed together?

The updated guidelines for 2021 instruct providers to use CPT code 11970 together with CPT code 19370 (Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy) in that scenario.

What is the CPT code for revision of reconstructed breast?

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.

What is the major difference between a modified radical mastectomy and a radical mastectomy?

Both radical and modified radical mastectomy include removing the entire breast. During a modified radical mastectomy, the surgeon removes some underarm lymph nodes. The key difference is that in a radical mastectomy, the surgeon removes all the underarm lymph nodes plus the entire chest muscle.

What is reconstruction surgery after a mastectomy?

Breast reconstruction is surgery to recreate breasts after a mastectomy. There are several types of breast reconstruction. Some techniques use implants. Others use tissue from your body (such as the belly) to form a breast. Breast reconstruction can happen right after a mastectomy or much later.

What is the difference between a bilateral mastectomy and a double mastectomy?

Double mastectomy When both breasts are removed, it is called a double (or bilateral) mastectomy. Double mastectomy is sometimes done as a risk-reducing (or preventive) surgery for women at very high risk for getting breast cancer, such as those with a BRCA gene mutation.

What is the code for radical mastectomy?

The code for this type of more involved mastectomy is 19305 .

What is a complete mastectomy?

Radical mastectomy. For female patients, partial mastectomy involves excising the mass from the breast, taking along with it a margin of healthy tissue. The title of the procedure will be important when determining the physician’s intention for the procedure.

What is subcutaneous mastectomy?

During a subcutaneous mastectomy (19304), the surgeon dissects the breast away from the pectoral fascia and skin. As with the simple complete mastectomy, the surgeon removes all of the breast tissue, but spares the skin and pectoral fascia. The documentation should clearly illustrate the more complex nature of this procedure.

What is a TRAM reconstruction?

TRAM reconstruction involves using the skin and muscles from the abdomen to create a breast. The advantage to this technique is that the tissue remains attached to its blood supply. For a single pedicle flap, report 19367. If the surgeon uses two pedicles of the rectus abdominis, report 19369.

What is the procedure to transfer skin from another part of the body to the breast area?

Three additional reconstruction procedures include transferring skin from another part of the patient’s body to the breast area. The latissimus dorsi flap (19361) describes a procedure during which muscle and skin are taken from the patient’s back and used to reconstruct a breast.

Can breast implants be done at the same time as mastectomy?

Breast implants are, perhaps, the most well-known reconstruction methods. These can be done during the same surgical session as the mastectomy (19340) or at a later time (19342). If reconstruction is delayed, the surgeon may perform a tissue expansion (19357).

Is breast reconstruction surgery risky?

As with any surgery, there are risks to the reconstruction procedures, including the potential removal of the implanted prosthetic if a complication occurs. The size of the breast and the defect may also be factors in deciding which reconstruction method is best for the patient.

What is the ICd 10 code for breast reconstruction?

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 you include decimal points in ICD-10?

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:

Description Information

Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Transmittal Information

08/1989 - Clarified coverage following a medically necessary mastectomy, and included applicable ICD-9-CM and HCPCS codes. Effective date NA. (TN 40)