| Code | Description |
|---|---|
| ICD-9-CM procedure codes | |
| 11970a | Replacement of tissue expander with permanent prosthesis |
| 19340a | Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction |
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.
Your individual results will depend on factors, such as:
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 ...
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 .
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.
19303Table 2ICD-9-CM and CPT procedure codes defining mastectomiesCodeDescriptionICD-9-CM procedure codes19303Mastectomy, simple complete19304Mastectomy, subcutaneous19305Mastectomy, radical15 more rows
2022 ICD-10-PCS Procedure Code 0HBV0ZZ.
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.
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.
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.
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.
ICD-9-CM is the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States. The ICD-9 was used to code and classify mortality data from death certificates until 1999, when use of ICD-10 for mortality coding started.
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.
The correct code to report skin-sparing mastectomy is 19303, Mastectomy, simple, complete (total mastectomy).
V51.0 is a legacy non-billable code used to specify a medical diagnosis of encounter for breast reconstruction following mastectomy. This code was replaced on September 30, 2015 by its ICD-10 equivalent.
The following crosswalk between ICD-9 to ICD-10 is based based on the General Equivalence Mappings (GEMS) information:
The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-9 Code Edits are applicable to this code:
If you need a mastectomy, you have a choice about whether or not to have surgery to rebuild the shape of the breast. Instead of breast reconstruction, you could choose to wear a breast form that replaces the breast, wear padding inside your bra, or do nothing. All of these options have pros and cons.
General Equivalence Map Definitions The ICD-9 and ICD-10 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
08/1989 - Clarified coverage following a medically necessary mastectomy, and included applicable ICD-9-CM and HCPCS codes. Effective date NA. (TN 40)