what is the icd 10 code for a modified radical mastectomy

by Dr. Judy Morissette Sr. 10 min read

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.

Full Answer

What is removed during a modified radical mastectomy?

This finding led him to create the modified radical mastectomy. During a modified radical mastectomy, a surgeon removes a person’s breast, areola, and nipple, along with lymph nodes under the arm. Unless the surgeon discovers that the tumor has spread, they leave the muscles of the chest wall intact.

What to know about modified radical mastectomy?

A modified radical mastectomy is a surgical procedure that removes the entire breast, including all or some overlying skin, nipple and areola, the surrounding lymph nodes in the armpit, and the lining of the chest muscles. The surgeon may also remove some of the chest wall muscle. The surgery will aim to preserve as much healthy tissue as possible.

Is the CPT code the same as the procedure code?

When a service or procedure is described the same by both CPT coding and HCPCS coding, the CPT code is used. When a CPT code includes instructions to add more information, a HCPCS code is used. There are 16 sections in the HCPCS manual. ADVERTISEMENT.

How are the incisions made in a modified radical mastectomy?

The surgeon will make an incision on one side of the chest and gently pull the skin back to reveal the breast tissue. She will remove the breast tissue and the axillary lymph nodes that are under the arm. Finally, the surgeon will insert thin tubes to drain any excess fluid from the breast area and then close the incision site.

What is the CPT code for 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 code for radical 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 difference between a mastectomy and a 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.

What is the ICD-10 PCS code for right total mastectomy open?

Excision of Bilateral Breast, Open Approach ICD-10-PCS 0HBV0ZZ is a specific/billable code that can be used to indicate a procedure.

How do you code a mastectomy?

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

What is removed in a modified radical mastectomy?

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.

Why is it called a radical mastectomy?

Radical mastectomy. The whole breast, all of the lymph nodes under the arm, and the chest wall muscles under the breast are removed. For many years, radical mastectomy was the type of breast cancer surgery used most often, but it is rarely used now.

Why do a modified radical mastectomy?

Procedure for a modified radical mastectomy The overall goal of an MRM is to remove all or most of the cancer present while preserving as much of the healthy skin tissue as possible. This makes it possible to perform an effective breast reconstruction after you've healed properly.

What is an extended radical mastectomy?

An extended radical mastectomy is the standard radical mastectomy plus the removal of the internal mammary nodes. In the modified radical mastectomy, the procedure involves removal of the breast but preservation of the pectoralis major muscle.

What is the ICD-10 code for left mastectomy?

ICD-10 code Z90. 12 for Acquired absence of left breast and nipple is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .

Are there ICD-10 procedure codes?

ICD-10-PCS will be the official system of assigning codes to procedures associated with hospital utilization in the United States. ICD-10-PCS codes will support data collection, payment and electronic health records. ICD-10-PCS is a medical classification coding system for procedural codes.

Where in the ICD-10-PCS coding manual can a coder find all the root operation definitions explanation and examples?

Most PCS codes reported for the inpatient setting are found in the Medical and Surgical section of ICD-10-PCS. There are 31 root operations in this section. The entire list can be found with definitions and examples beginning on page 117 of the ICD-10-PCS Reference Manual.

What is included in CPT 19357?

CPT 19357 is used for tissue expander placement in breast reconstruction; includes subsequent expansion(s); and is separately re- portable if used in flap reconstruction.

What is procedure code 38900?

CPT code +38900 is used for the intraoperative identification (e.g., mapping) of sentinel lymph node(s) and includes injection of non-radioactive dye, when performed.

What does CPT code 19380 include?

CPT code 19380, Revision of reconstructed breast involves revising an already reconstructed breast. The code includes repositioning the breast; making adjustments to the inframammary crease; making capsular adjustments; and performing scar revisions, fat grafting, liposuction, and so on.

What does CPT code 19350 include?

CPT® Code 19350 in section: Repair and/or Reconstruction Procedures on the Breast.

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 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).

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.

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