icd 9 code for complications after mastectomy

Full Answer

Does ICD-9-CM code for surgical site infection after mastectomy?

Background Few studies have validated ICD-9-CM diagnosis codes for surgical site infection (SSI), and none have validated coding for noninfectious wound complications after mastectomy.

What is the ICD 9 code for postoperative seroma?

Eleven of the 13 false-positive SSIs with medical record documentation of seroma had been coded with the ICD-9-CM diagnosis code 998.51 (infected postoperative seroma). The most common error in coding of noninfectious wound complications involved incorrect use of a code for a different wound complication.

Why are mastectomy and reconstruction so complicated to code?

The complexities of coding mastectomy and reconstruction seem to parallel the complexities of the surgery itself. A simple mastectomy may be simple to code. More complicated cases may take some analysis and interpretation of coding rules. For example, in advanced tumors, the volume of tissue removed sometimes precludes simple closure.

What is the CPT code for mastectomy with lymph nodes removed?

The code for this type of more involved mastectomy is 19305. When both axillary lymph nodes and the internal mammary lymph nodes are taken during this operative session, the pectoralis major and minor can be spared. If the physician performs this procedure (also known as the Urban-type mastectomy), report 19306.

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 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-9 code for mastectomy?

Table 2ICD-9-CM and CPT procedure codes defining mastectomiesCodeDescriptionICD-9-CM procedure codes19304Mastectomy, subcutaneous19305Mastectomy, radical19306Mastectomy, radical, urban type15 more rows

What is the ICD-10 code for aftercare?

Aftercare codes are found in categories Z42-Z49 and Z51. Aftercare is one of the 16 types of Z-codes covered in the 2012 ICD-10-CM Official Guidelines and Reporting.

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.

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.

How do you code a mastectomy?

Report code 19303, Mastectomy, simple, complete, for the mastectomy.

What are ICD-9 procedure codes?

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.

What's the CPT code for a patient receiving a modified radical mastectomy?

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.

What is the ICD 10 code for post op surgery?

ICD-10 Code for Encounter for surgical aftercare following surgery on specified body systems- Z48. 81- Codify by AAPC.

What is the ICD 10 code for aftercare following surgery?

81: Encounter for surgical aftercare following surgery on specified body systems.

What is the difference between Z21 and B20?

Following ICD-10 guidelines, if a patient has or has had an HIV related condition, use B20 AIDS. If the patient has a positive HIV status, without symptoms or related conditions, use Z21.

Abstract

BACKGROUND Few studies have validated ICD-9-CM diagnosis codes for surgical site infection (SSI), and none have validated coding for noninfectious wound complications after mastectomy.

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Abstract

Few studies have validated ICD-9-CM diagnosis codes for surgical site infection (SSI), and none have validated coding for noninfectious wound complications after mastectomy.

METHODS

From the HealthCore Integrated Research Database, a private insurer claims database, we established a retrospective cohort of women 18–64 years of age that had an ICD-9-CM procedure code or a CPT-4 code for mastectomy between January 1, 2004, and August 31, 2009, as described previously (see Supplemental Table 1). Reference Olsen, Nickel and Fox 4 Newly coded SSIs, cellulitis, hematoma, seroma, dehiscence, fat necrosis, and tissue necrosis were identified by ICD-9-CM diagnosis codes in inpatient and outpatient facility and provider claims from 2 to 180 days after mastectomy (day 0 for hematoma), as described previously. Reference Olsen, Nickel and Fox 4 , Reference Nickel, Fox, Margenthaler, Wallace, Fraser and Olsen 5 The complication algorithm included diagnosis codes specific to breast complications (eg, 611.3 for fat necrosis), and general postoperative complications (eg, 998.59 for SSI) (Supplemental Tables 2 and 3)..

RESULTS

We obtained medical records of 275 women coded in the claims data for mastectomy; 260 records (94.5%) included information regarding whether mastectomy was performed. The records showed that 2 women had undergone breast-conserving surgery rather than mastectomy, yielding a PPV for mastectomy codes of 99.2%.

DISCUSSION

The PPVs of our ICD-9-CM diagnosis code algorithms to identify infectious and noninfectious complications after mastectomy were variable but generally showed moderate to good results. The PPVs of coding for SSI ranged from 58% to 69% depending on whether cellulitis-alone was considered to meet the SSI definition.

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 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 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.

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.

Can mastectomies be performed for cancer?

While some excisions may be performed for benign conditions, most mastectomies are performed for malignancy. About two-thirds of breast cancers require estrogen to thrive, and can therefore be managed with estrogen-blocking drugs. These drugs reduce the chance of the cancer recurring and improve survival rates.