Encounter for breast reconstruction following mastectomy ICD-10-CM Diagnosis Code Z90.13 [convert to ICD-9-CM] Acquired absence of bilateral breasts and nipples
deformity and disproportion of reconstructed breast ( ICD-10-CM Diagnosis Code N65.1. Disproportion of reconstructed breast 2016 2017 2018 2019 2020 Billable/Specific Code Adult Dx (15-124 years) Applicable To Breast asymmetry between native breast and reconstructed breast. Disproportion between native breast and reconstructed breast.
encounter for initial breast implant insertion for cosmetic breast augmentation ( Z41.1) encounter for breast reconstruction following mastectomy ( Z42.1) ICD-10-CM Diagnosis Code N64.89 [convert to ICD-9-CM] Other specified disorders of breast.
The documentation should clearly illustrate the more complex nature of this procedure. A radical mastectomy occurs when the surgeon removes the complete breast, the skin, the pectoralis major muscle, pectoralis minor muscle and the axillary lymph nodes at the same time. The code for this type of more involved mastectomy is 19305.
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.
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.
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.
ICD-10-CM Code for Encounter for adjustment or removal of breast implant Z45. 81.
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.
Table 2.CPT CodeDescription15770Formation of direct or tubed pedicle, with or without transfer, trunk19316Mastopexy19318Reduction mammoplasty19366Breast reconstruction with other technique7 more rows•Dec 17, 2020
Listen to pronunciation. (MAH-dih-FIDE RA-dih-kul ma-STEK-toh-mee) Surgery to remove the whole breast, which may include the nipple, areola (the dark-colored skin around the nipple), and skin over the breast. Most of the lymph nodes under the arm are also removed.
Assign code 51 or 52 if a patient has an excisional biopsy and axillary dissection followed by a simple mastectomy during the first course of therapy. Code the cumulative result of the surgeries, which is a modified radical mastectomy in this case.
Report code 19303, Mastectomy, simple, complete, for the mastectomy.
Answer: Capsulectomy "En bloc" refers to removing the capsule and the implant as one unit. With a total capsulectomy the complete capsule is removed, but may or may not be done separately from the implant. The term "bilateral" simply refers to both breasts versus one.
CPT® Code 19328 in section: Repair and/or Reconstruction Procedures on the Breast.
Personal history of breast implant removal The 2022 edition of ICD-10-CM Z98. 86 became effective on October 1, 2021. This is the American ICD-10-CM version of Z98.
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.
CPT® 19340, Under Repair and/or Reconstruction Procedures on the Breast. The Current Procedural Terminology (CPT®) code 19340 as maintained by American Medical Association, is a medical procedural code under the range - Repair and/or Reconstruction Procedures on the Breast.
The only code needed is 19380 for Revision of reconstructed breast. Replacement of a permanent breast implant is not included in code 19380. If the patient is having a new implant inserted, perhaps to a different size, either code 19340 or 19342 can be assigned separately.
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.
A type 1 excludes note is a pure excludes. It means "not coded here". A type 1 excludes note indicates that the code excluded should never be used at the same time as Z42.1. A type 1 excludes note is for used for when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
Categories Z40-Z53 are intended for use to indicate a reason for care. They may be used for patients who have already been treated for a disease or injury, but who are receiving aftercare or prophylactic care, or care to consolidate the treatment, or to deal with a residual state. Type 2 Excludes.
The 2022 edition of ICD-10-CM Z42.1 became effective on October 1, 2021.
The code for this type of more involved mastectomy is 19305 .
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.
The government passed the Women’s Health and Cancer Act (WHCRA) of 1998, enforcing coverage of reconstruction following mastectomies (if the plan allows for mastectomies). Check with your state’s Department of Insurance for your state’s coverage requirements.
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.
If the physician also performed sentinel node or other axillary node excision, report 19302. Remember that sentinel node injection is separately reported with 38792. If the surgeon removes all (rather than just a portion) of the breast tissue, report a simple total mastectomy using 19303.
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.
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.
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:
Z42.1 is exempt from POA reporting ( Present On Admission).
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Please use diagnosis code: Z41.1 Encounter for cosmetic surgery.
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