ICD-10 Coding for Right Mastectomy(Z90.11, C50.911, Z42.1)
Complete ICD-10-CM coding and documentation guide for Right Mastectomy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Mastectomy
Z42-Z90Primary Range
Encounter for follow-up examination after treatment for conditions other than malignant neoplasm
This range includes codes for post-surgical follow-up and reconstruction after mastectomy.
Malignant neoplasm of breast
This range includes codes for active breast cancer, which may necessitate a mastectomy.
Personal history of malignant neoplasm
This range includes codes for history of breast cancer, relevant for delayed reconstruction.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z90.11 | Acquired absence of right breast | Use for all encounters following a right mastectomy. |
|
| C50.911 | Malignant neoplasm of unspecified site of right female breast | Use when active cancer is present in the right breast. |
|
| Z42.1 | Encounter for breast reconstruction following mastectomy | Use for encounters focused on reconstruction post-mastectomy. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for right mastectomy
Essential facts and insights about Right Mastectomy
Primary ICD-10-CM Codes for right mastectomy
Decision Criteria
clinical Criteria
- Documentation of right breast removal
Applicable To
- Post-mastectomy status
Excludes
- Congenital absence of breast
Clinical Validation Requirements
- Operative report confirming right mastectomy
- Clinical notes indicating absence of right breast
Code-Specific Risks
- Ensure documentation clearly states the side of the mastectomy.
Coding Notes
- Always confirm the side of the mastectomy in documentation.
C50.911 - Malignant neoplasm of unspecified site of right female breast
Use when active cancer is present in the right breast.
Applicable To
- Invasive ductal carcinoma of right breast
Excludes
- Benign neoplasm of breast
Clinical Validation Requirements
- Pathology report confirming malignancy
- Imaging studies showing tumor in right breast
Coding Notes
Ensure current cancer status is documented.
Z42.1 - Encounter for breast reconstruction following mastectomy
Use for encounters focused on reconstruction post-mastectomy.
Applicable To
- Reconstruction post-mastectomy
Excludes
- Cosmetic breast surgery
Clinical Validation Requirements
- Operative report detailing reconstruction procedure
Coding Notes
Document the type and timing of reconstruction.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for breast reconstruction following mastectomy
Z42.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Right Mastectomy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z90.11.
Impact
Clinical: Inaccurate cancer staging, Regulatory: Potential audit issues, Financial: Reimbursement discrepancies
Mitigation Strategy
Include lymph node status in operative notes, Cross-check with pathology report
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Use Z85.3 for history of breast cancer.
Impact
Incorrect linkage of reconstruction codes to mastectomy.
Mitigation Strategy
Verify documentation of mastectomy and reconstruction linkage.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Right Mastectomy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Mastectomy
Use these documentation templates to ensure complete and accurate documentation for Right Mastectomy. These templates include all required elements for proper coding and billing.
Right mastectomy with immediate reconstruction
Specialty: Surgical OncologyRequired Elements
- Procedure type
- Tumor size
- Lymph node involvement
- Reconstruction details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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