ICD-10 Coding for Mastectomy(C50.911, Z90.13)
Complete ICD-10-CM coding and documentation guide for Mastectomy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to 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 |
|---|---|---|---|
| C50.911 | Malignant neoplasm of unspecified site of right female breast | Use when documenting active breast cancer in the right breast. |
|
| Z90.13 | Acquired absence of bilateral breasts and nipples | Use for patients with a history of bilateral 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 mastectomy
Essential facts and insights about Mastectomy
Primary ICD-10-CM Codes for mastectomy
Decision Criteria
clinical Criteria
- Confirmed diagnosis of breast cancer in the right breast
Applicable To
- Breast cancer
Excludes
- Benign breast neoplasm
Clinical Validation Requirements
- Pathology report confirming malignancy
- Imaging findings consistent with breast cancer
Code-Specific Risks
- Incorrect laterality documentation
Coding Notes
- Ensure laterality is correctly documented.
Z90.13 - Acquired absence of bilateral breasts and nipples
Use for patients with a history of bilateral mastectomy.
Applicable To
- History of bilateral mastectomy
Excludes
- Current breast cancer treatment
Clinical Validation Requirements
- Surgical history indicating bilateral mastectomy
Coding Notes
Document surgical history clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Acquired absence of right breast and nipple
Z90.11Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Mastectomy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C50.911.
Impact
Clinical: Incomplete surgical record., Regulatory: Potential audit risk., Financial: Loss of reimbursement for reconstruction.
Mitigation Strategy
Include reconstruction details in operative notes.
Impact
Reimbursement: Claims may be denied or delayed., Compliance: Non-compliance with coding standards., Data Quality: Inaccurate patient records.
Mitigation Strategy
Verify laterality in the medical record before coding.
Impact
Incorrect documentation of breast side.
Mitigation Strategy
Double-check laterality in patient records.
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 Mastectomy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Mastectomy
Use these documentation templates to ensure complete and accurate documentation for Mastectomy. These templates include all required elements for proper coding and billing.
Skin-sparing mastectomy with reconstruction
Specialty: Surgical OncologyRequired Elements
- Procedure type
- Margins
- Lymph node status
- Reconstruction details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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