icd 9 code for prophylactic mastectomy

V07.8 would be the code you would use if the patient was (in need of) having prophylactic breast removal, as stated in your Tabular List under this code. However, if the patient has already received the mastectomy, the proper code would be V45.71.

Full Answer

What is the ICD 9 code for mastectomy?

19303Table 2ICD-9-CM and CPT procedure codes defining mastectomiesCodeDescriptionICD-9-CM procedure codes19303Mastectomy, simple complete19304Mastectomy, subcutaneous19305Mastectomy, radical15 more rows

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 mastectomy?

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

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.

What is the ICD-10 code for right prophylactic mastectomy?

Z40. 01 - Encounter for prophylactic removal of breast | ICD-10-CM.

What is the ICD-10 code for left mastectomy?

ICD-10 Code for Acquired absence of left breast and nipple- Z90. 12- Codify by AAPC.

What is the difference between 50 modifier or RT LT?

Modifier LT or RT should be used to identify which of the paired organs was operated on. Billing procedures as two lines of service using the LT and RT modifiers is not the same as identifying the procedure with modifier 50. Modifier 50 is the coding practice of choice when reporting bilateral procedures.

What is the CPT code for bilateral skin sparing mastectomy?

To summarize, report code 19303 for a skin-sparing or nipple-sparing mastectomy for diagnosed carcinoma or for patients who are at high risk for carcinoma, regardless of the amount of skin removed or whether the nipple is preserved.

What is the difference between CPT code 19301 and 19125?

CPT 19125 the lesion is identified by preoperative placement of radiological marker. 19301 is a partial mastectomy or lumpectomy. There is also NO radiological marker placement.

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 diagnosis code Z80 3?

Breast Cancer ICD-10 Code Reference SheetPERSONAL OR FAMILY HISTORY*Z85.3Personal history of malignant neoplasm of breastZ80.3Family history of malignant neoplasm of breast

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 a prophylactic mastectomy?

Prophylactic mastectomy is defined as the removal of the breast in the absence of malignant disease. Prophylactic mastectomies may be performed in women considered at high risk of developing breast cancer, either due to a family history, presence of a BRCA1, BRCA2, or PALB2 gene mutation, or the presence of lesions associated with an increased ...

What is current medical policy?

Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage.

What is a strong family history of breast cancer?

Those with a strong family history of breast cancer such as: Having a mother, sister, and/or daughter who was diagnosed with bilateral breast cancer or with breast cancer before age 50 years; or.

Is a mastectomy necessary for lobular carcinoma?

Prophylactic mastectomy may be considered medically necessary when ONE or more of the following risk factors are present: Individuals with lobular carcinoma in situ (LCIS) plus a family history of breast cancer. Mastectomy of the contralateral breast may be considered medically necessary when ONE or more of the following situations exists: ...

Should medical policy be considered before utilizing medical opinion in adjudication?

Likewise, medical policy, which addresses the issue (s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving and the Company reserves the right to review and update medical policy periodically.

Is a breast mastectomy necessary?

Mastectomy of the contralateral breast may be considered medically necessary when ONE or more of the following situations exists: Disproportionately sized contralateral breast. Coverage for reconstructive breast surgery is provided for individuals undergoing covered prophylactic mastectomies.