Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 11.08.14j


Attachment:A

Policy #:11.08.14j

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.



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 breas

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

C79.81 Secondary malignant neoplasm of breast

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

T81.30xA Disruption of wound, unspecified, initial encounter

T81.30xD Disruption of wound, unspecified, subsequent encounter

T81.30xS Disruption of wound, unspecified, sequela

T81.31xA Disruption of external operation (surgical) wound, not elsewhere classified, initial encounter

T81.31xD Disruption of external operation (surgical) wound, not elsewhere classified, subsequent encounter

T81.31xS Disruption of external operation (surgical) wound, not elsewhere classified, sequela

T81.32xA Disruption of internal operation (surgical) wound, not elsewhere classified, initial encounter

T81.32xD Disruption of internal operation (surgical) wound, not elsewhere classified, subsequent encounter

T81.32xS Disruption of internal operation (surgical) wound, not elsewhere classified, sequela

T81.40XA Infection following a procedure, unspecified, initial encounter

T81.40XD Infection following a procedure, unspecified, subsequent encounter

T81.40XS Infection following a procedure, unspecified, sequela

T81.41XA Infection following a procedure, superficial incisional surgical site, initial encounter

T81.41XD Infection following a procedure, superficial incisional surgical site, subsequent encounter

T81.41XS Infection following a procedure, superficial incisional surgical site, sequela

T81.42XA Infection following a procedure, deep incisional surgical site, initial encounter

T81.42XD Infection following a procedure, deep incisional surgical site, subsequent encounter

T81.42XS Infection following a procedure, deep incisional surgical site, sequela

T81.43XA Infection following a procedure, organ and space surgical site, initial encounter

T81.43XD Infection following a procedure, organ and space surgical site, subsequent encounter

T81.43XS Infection following a procedure, organ and space surgical site, sequela

T81.44XA Sepsis following a procedure, initial encounter

T81.44XD Sepsis following a procedure, subsequent encounter

T81.44XS Sepsis following a procedure, sequela

T81.49XA Infection following a procedure, other surgical site, initial encounter

T81.49XD Infection following a procedure, other surgical site, subsequent encounter

T81.49XS Infection following a procedure, other surgical site, sequela

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

T85.818A Embolism due to other internal prosthetic devices, implants and grafts, initial encounter

T85.818D Embolism due to other internal prosthetic devices, implants and grafts, subsequent encounter

T85.818S Embolism due to other internal prosthetic devices, implants and grafts, sequela

T85.828A Fibrosis due to other internal prosthetic devices, implants and grafts, initial encounter

T85.828D Fibrosis due to other internal prosthetic devices, implants and grafts, subsequent encounter

T85.828S Fibrosis due to other internal prosthetic devices, implants and grafts, sequela

T85.838A Hemorrhage due to other internal prosthetic devices, implants and grafts, initial encounter

T85.838D Hemorrhage due to other internal prosthetic devices, implants and grafts, subsequent encounter

T85.838S Hemorrhage due to other internal prosthetic devices, implants and grafts, sequela

T85.848A Pain due to other internal prosthetic devices, implants and grafts, initial encounter

T85.848D Pain due to other internal prosthetic devices, implants and grafts, subsequent encounter

T85.848S Pain due to other internal prosthetic devices, implants and grafts, sequela

Z44.30 Encounter for fitting and adjustment of external breast prosthesis, unspecified breast

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

Z85.3 Personal history of malignant neoplasm of breast

Z90.10 Acquired absence of unspecified breast and nipple

Z90.11 Acquired absence of right breast and nipple

Z90.12 Acquired absence of left breast and nipple

Z90.13 Acquired absence of bilateral breasts and nipples

Version Effective Date: 10/01/2018
Version Issued Date: 10/01/2018
Version Reissued Date: N/A

Connect with Us        


2017 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.