ICD-10 Coding for Left Mastectomy(Z90.12, C50.212)
Complete ICD-10-CM coding and documentation guide for Left Mastectomy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Left Mastectomy
Z90-Z99Primary Range
Persons with potential health hazards related to family and personal history and certain conditions influencing health status
Includes codes for acquired absence of organs, such as the breast, following mastectomy.
Malignant neoplasm of breast
Used when coding for breast cancer, which may necessitate a mastectomy.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z90.12 | Acquired absence of left breast and nipple | Use for patients with a history of left mastectomy. |
|
| C50.212 | Malignant neoplasm of upper-inner quadrant of left female breast | Use when documenting a malignant tumor in the specified location. |
|
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 left mastectomy
Essential facts and insights about Left Mastectomy
Primary ICD-10-CM Codes for left mastectomy
Decision Criteria
documentation Criteria
- Operative report must specify left breast removal.
Applicable To
- Post-mastectomy status of left breast
Excludes
- Congenital absence of breast (Q83.0)
Clinical Validation Requirements
- Operative report confirming mastectomy
- Pathology report indicating absence of left breast
Code-Specific Risks
- Ensure documentation specifies laterality.
Coding Notes
- Ensure proper sequencing with malignancy codes if applicable.
C50.212 - Malignant neoplasm of upper-inner quadrant of left female breast
Use when documenting a malignant tumor in the specified location.
Applicable To
- Breast cancer in the upper-inner quadrant of the left breast
Excludes
- Benign neoplasm of breast (D24.-)
Clinical Validation Requirements
- Pathology report confirming malignancy
- Imaging studies showing tumor location
Coding Notes
Ensure alignment with surgical procedure codes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for prophylactic surgery for risk factors related to malignant neoplasms
Z40.00Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Left Mastectomy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z90.12.
Impact
Clinical: Ambiguity in patient records., Regulatory: Non-compliance with coding guidelines., Financial: Potential claim denials.
Mitigation Strategy
Always specify left or right in documentation., Use templates that prompt for laterality.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding standards., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use 19301 for partial mastectomy when margins are addressed.
Impact
Improper sequencing can lead to audit flags.
Mitigation Strategy
Follow coding guidelines for sequencing.
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 Left Mastectomy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Left Mastectomy
Use these documentation templates to ensure complete and accurate documentation for Left Mastectomy. These templates include all required elements for proper coding and billing.
Left modified radical mastectomy
Specialty: Surgical OncologyRequired Elements
- Type of mastectomy
- Axillary lymph node dissection
- Reconstruction details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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