Notification



Notification Issue Date:



Policy Attachment

Attachment to Policy # MA11.076c


Attachment:A

Policy #:MA11.076c

Description:ICD-10-CM codes

Title:Removal of Breast Implants


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.



ICD-10-CM codes

C50.011 Malignant neoplasm of nipple and areola, right female breast

C50.012 Malignant neoplasm of nipple and areola, left female breast

C50.019 Malignant neoplasm of nipple and areola, unspecified female breast

C50.111 Malignant neoplasm of central portion of right female breast

C50.112 Malignant neoplasm of central portion of left female breast

C50.119 Malignant neoplasm of central portion of unspecified female breast

C50.211 Malignant neoplasm of upper-inner quadrant of right female breast

C50.212 Malignant neoplasm of upper-inner quadrant of left female breast

C50.219 Malignant neoplasm of upper-inner quadrant of unspecified female breast

C50.311 Malignant neoplasm of lower-inner quadrant of right female breast

C50.312 Malignant neoplasm of lower-inner quadrant of left female breast

C50.319 Malignant neoplasm of lower-inner quadrant of unspecified female breast

C50.411 Malignant neoplasm of upper-outer quadrant of right female breast

C50.412 Malignant neoplasm of upper-outer quadrant of left female breast

C50.419 Malignant neoplasm of upper-outer quadrant of unspecified female breast

C50.511 Malignant neoplasm of lower-outer quadrant of right female breast

C50.512 Malignant neoplasm of lower-outer quadrant of left female breast

C50.519 Malignant neoplasm of lower-outer quadrant of unspecified female breast

C50.611 Malignant neoplasm of axillary tail of right female breast

C50.612 Malignant neoplasm of axillary tail of left female breast

C50.619 Malignant neoplasm of axillary tail of unspecified female breast

C50.811 Malignant neoplasm of overlapping sites of right female breast

C50.812 Malignant neoplasm of overlapping sites of left female breast

C50.819 Malignant neoplasm of overlapping sites of unspecified female breast

C50.911 Malignant neoplasm of unspecified site of right female breast

C50.912 Malignant neoplasm of unspecified site of left female breast

C50.919 Malignant neoplasm of unspecified site of unspecified female breast

C79.2 Secondary malignant neoplasm of skin

C79.81 Secondary malignant neoplasm of breast

D04.5 Carcinoma in situ of skin of trunk

D05.00 Lobular carcinoma in situ of unspecified breast

D05.01 Lobular carcinoma in situ of right breast

D05.02 Lobular carcinoma in situ of left breast

D05.10 Intraductal carcinoma in situ of unspecified breast

D05.11 Intraductal carcinoma in situ of right breast

D05.12 Intraductal carcinoma in situ of left breast

D05.80 Other specified type of carcinoma in situ of unspecified breast

D05.81 Other specified type of carcinoma in situ of right breast

D05.82 Other specified type of carcinoma in situ of left breast

D05.90 Unspecified type of carcinoma in situ of unspecified breast

D05.91 Unspecified type of carcinoma in situ of right breast

D05.92 Unspecified type of carcinoma in situ of left breast

D24.1 Benign neoplasm of right breast

D24.2 Benign neoplasm of left breast

D24.9 Benign neoplasm of unspecified breast

D48.60 Neoplasm of uncertain behavior of unspecified breast

D48.61 Neoplasm of uncertain behavior of right breast

D48.62 Neoplasm of uncertain behavior of left breast

D49.3 Neoplasm of unspecified behavior of breast

N65.0 Deformity of reconstructed breast

N65.1 Disproportion of reconstructed breast

T85.41xA Breakdown (mechanical) of breast prosthesis and implant, initial encounter

T85.41xD Breakdown (mechanical) of breast prosthesis and implant, subsequent encounter

T85.41xS Breakdown (mechanical) of breast prosthesis and implant, sequela

T85.42xA Displacement of breast prosthesis and implant, initial encounter

T85.42xD Displacement of breast prosthesis and implant, subsequent encounter

T85.42xS Displacement of breast prosthesis and implant, sequela

T85.43xA Leakage of breast prosthesis and implant, initial encounter

T85.43xD Leakage of breast prosthesis and implant, subsequent encounter

T85.43xS Leakage of breast prosthesis and implant, sequela

T85.44xA Capsular contracture of breast implant, initial encounter

T85.44xD Capsular contracture of breast implant, subsequent encounter

T85.44xS Capsular contracture of breast implant, sequela

T85.49xA Other mechanical complication of breast prosthesis and implant, initial encounter

T85.49xD Other mechanical complication of breast prosthesis and implant, subsequent encounter

T85.49xS Other mechanical complication of breast prosthesis and implant, sequela

T85.79xA Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter

T85.79xD Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, subsequent encounter

T85.79xS Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, sequela

Z44.31 Encounter for fitting and adjustment of external right breast prosthesis

Z44.32 Encounter for fitting and adjustment of external left breast prosthesis

Z45.811 Encounter for adjustment or removal of right breast implant

Z45.812 Encounter for adjustment or removal of left breast implant

Z45.819 Encounter for adjustment or removal of unspecified breast implant

Z48.3 Aftercare following surgery for neoplasm

Z85.3 Personal history of malignant neoplasm of breast

Z98.82 Breast implant status

Version Effective Date: 10/01/2016
Version Issued Date: 10/01/2016
Version Reissued Date: 04/25/2018

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