icd 10 procedure code for breast reconstruction

What is the CPT code for breast reconstruction?

• Understand 2 Reconstruction Categories. CPT® 2021 indicates that the goal of breast reconstruction is to restore form and symmetry following surgery, or otherwise correct anatomic defect.
• Distinguish Post Mastectomy Autologous Reconstruction. ...
• Check Out Native Breast Alteration. ...

What ICD 10 cm code(s) are reported?

What is ICD-10-CM, ICD-10-PCS, CPT, and HCPCS?

• ICD-10-CM, ICD-10-PCS, CPT, and HCPCS. If you are new to medical coding, you may not know what these acronyms mean. ...
• Acronyms
• Code Sets and Their Definitions. The following are the definitions for each code set. CMS maintains this code set, except for dental services (D codes).

What is the ICD 10 code for removal of stitches?

Suture Removal from Upper Extremity

1. (effective 10/1/2015): New code (first year of non-draft ICD-10-PCS)
2. (effective 10/1/2016): No change
3. (effective 10/1/2017): No change
4. (effective 10/1/2018): No change
5. (effective 10/1/2019): No change
6. (effective 10/1/2020): No change

What is the ICD 10 code for diagnostic mammogram?

Z12.31 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Short description: Encntr screen mammogram for malignant neoplasm of breast The 2022 edition of ICD-10-CM Z12.31 became effective on October 1, 2021.

What is the ICD-10 code for status post 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.

What is the ICD-10 code for cosmetic surgery?

ICD-10 Code for Encounter for cosmetic surgery- Z41. 1- Codify by AAPC.

What is the ICD-10 code for breast?

Breast Cancer ICD-10 Code Reference SheetLeftC50.012Malignant neoplasm of nipple and areola, left female breastC50.112Malignant neoplasm of central portion, left female breastC50.212Malignant neoplasm of upper-inner quadrant, left female breastC50.312Malignant neoplasm of lower-inner quadrant, left female breast8 more rows

What is the ICD-10 code for double mastectomy?

ICD-10 Code for Acquired absence of bilateral breasts and nipples- Z90. 13- Codify by AAPC.

What is procedure code 15839?

Group 1CodeDescription15837EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); FOREARM OR HAND15838EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); SUBMENTAL FAT PAD15839EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); OTHER AREA40 more rows

What is procedure code 17380?

CodeDescription15876 - 15879SUCTION ASSISTED LIPECTOMY; HEAD AND NECK - SUCTION ASSISTED LIPECTOMY; LOWER EXTREMITY17340CRYOTHERAPY (CO2 SLUSH, LIQUID N2) FOR ACNE17360CHEMICAL EXFOLIATION FOR ACNE (EG, ACNE PASTE, ACID)17380ELECTROLYSIS EPILATION, EACH 30 MINUTES8 more rows

What is the ICD-10 code for right breast mass?

ICD-10 code N63. 1 for Unspecified lump in the right breast is a medical classification as listed by WHO under the range - Diseases of the genitourinary system .

What is the ICD-10 code for Mastodynia?

ICD-10 code: N64. 4 Mastodynia | gesund.bund.de.

What is code Z12 39?

39 (Encounter for other screening for malignant neoplasm of breast). Z12. 39 is the correct code to use when employing any other breast cancer screening technique (besides mammogram) and is generally used with breast MRIs.

What ICD-10 code is reported for post mastectomy of the left breast?

Z90. 12 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. 12 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 ICD-10 code for history of bilateral mastectomy?

Submit the appropriate ICD-10 diagnosis code that reflects a member's history of bilateral mastectomy, Z90. 13.

What is the code for radical mastectomy?

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

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 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 the Women's Health and Cancer Act?

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.

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).

General Information

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..

Article Guidance

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L38914, Cosmetic and Reconstructive Surgery. Please refer to the LCD for reasonable and necessary requirements.

ICD-10-CM Codes that Support Medical Necessity

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted. The following ICD-10-CM code supports medical necessity and provides coverage for (CPT) code: 15781 for Dermabrasion.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

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.

What type of surgery is required for breast reconstruction?

Breast reconstruction may require multiple surgeries, such as nipple and areola reconstruction and tattoo pigmentation, revision surgery involving the breast and/or donor site, and surgery on the opposite breast to correct asymmetry.

Does Aetna do reconstructive breast surgery?

Policy. Aetna considers reconstructive breast surgery medically necessary after a medically necessary mast ectomy or a medically necessary lumpectomy that results in a significant deformity (i.e., mastectomy or lumpectomy for treatment of or prophylaxis for breast cancer and mastectomy or lumpectomy performed for chronic, ...

Is breast underdeveloped?

In females, 1 breast may also be under-developed (hypoplastic) or absent (amastia). In some cases, affected individuals may also exhibit under-developed upper ribs and/or an abnormally short arm with under-developed forearm bones (i.e., ulna and radius) on the affected side.