2019 ICD-10-CM Diagnosis Code Z42.1

Encounter for breast reconstruction following mastectomy

    2016 2017 2018 2019 Billable/Specific Code Adult Dx (15-124 years) POA Exempt
  • Z42.1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
  • The 2019 edition of ICD-10-CM Z42.1 became effective on October 1, 2018.
  • This is the American ICD-10-CM version of Z42.1 - other international versions of ICD-10 Z42.1 may differ.
ICD-10-CM Coding Rules
  • Z42.1 is applicable to adult patients aged 15 - 124 years inclusive.
Type 1 Excludes
Type 1 Excludes Help
A type 1 excludes note is a pure excludes. It means "not coded here". A type 1 excludes note indicates that the code excluded should never be used at the same time as Z42.1. A type 1 excludes note is for used for when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
  • deformity and disproportion of reconstructed breast (
    ICD-10-CM Diagnosis Code N65.1

    Disproportion of reconstructed breast

      2016 2017 2018 2019 Billable/Specific Code Adult Dx (15-124 years)
    Applicable To
    • Breast asymmetry between native breast and reconstructed breast
    • Disproportion between native breast and reconstructed breast
    N65.1-
    )
The following code(s) above Z42.1 contain annotation back-references
Annotation Back-References
In this context, annotation back-references refer to codes that contain:
  • Applicable To annotations, or
  • Code Also annotations, or
  • Code First annotations, or
  • Excludes1 annotations, or
  • Excludes2 annotations, or
  • Includes annotations, or
  • Note annotations, or
  • Use Additional annotations
that may be applicable to Z42.1:
  • Z00-Z99
    2019 ICD-10-CM Range Z00-Z99

    Factors influencing health status and contact with health services

    Note
    • Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
    • (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
    • (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.
    Factors influencing health status and contact with health services
  • Z40-Z53
    2019 ICD-10-CM Range Z40-Z53

    Encounters for other specific health care

    Applicable To
    • Categories Z40-Z53 are intended for use to indicate a reason for care. They may be used for patients who have already been treated for a disease or injury, but who are receiving aftercare or prophylactic care, or care to consolidate the treatment, or to deal with a residual state
    Type 2 Excludes
    • follow-up examination for medical surveillance after treatment (Z08-Z09)
    Encounters for other specific health care
  • Z42
    ICD-10-CM Diagnosis Code Z42

    Encounter for plastic and reconstructive surgery following medical procedure or healed injury

      2016 2017 2018 2019 Non-Billable/Non-Specific Code
    Type 1 Excludes
    • encounter for cosmetic plastic surgery (Z41.1)
    • encounter for plastic surgery for treatment of current injury - code to relevent injury
    Encounter for plastic and reconstructive surgery following medical procedure or healed injury
Present On Admission
POA Help
"Present On Admission" is defined as present at the time the order for inpatient admission occurs — conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered POA.
  • Z42.1 is considered exempt from POA reporting.
ICD-10-CM Z42.1 is grouped within Diagnostic Related Group(s) (MS-DRG v36.0):
  • 606 Minor skin disorders with mcc
  • 607 Minor skin disorders without mcc

Convert Z42.1 to ICD-9-CM

Code History
  • 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)
  • 2017 (effective 10/1/2016): No change
  • 2018 (effective 10/1/2017): No change
  • 2019 (effective 10/1/2018): No change
Code annotations containing back-references to Z42.1:
  • Type 1 Excludes: Z41.1
    , Z44.3
    , Z45.81
    ICD-10-CM Diagnosis Code Z41.1

    Encounter for cosmetic surgery

      2016 2017 2018 2019 Billable/Specific Code POA Exempt
    Applicable To
    • Encounter for cosmetic breast implant
    • Encounter for cosmetic procedure
    Type 1 Excludes
    • encounter for plastic and reconstructive surgery following medical procedure or healed injury (Z42.-)
    • encounter for post-mastectomy breast implantation (Z42.1)
    ICD-10-CM Diagnosis Code Z44.3

    Encounter for fitting and adjustment of external breast prosthesis

      2016 2017 2018 2019 Non-Billable/Non-Specific Code
    Type 1 Excludes
    • complications of breast implant (T85.4-)
    • encounter for adjustment or removal of breast implant (Z45.81-)
    • encounter for initial breast implant insertion for cosmetic breast augmentation (Z41.1)
    • encounter for breast reconstruction following mastectomy (Z42.1)
    ICD-10-CM Diagnosis Code Z45.81

    Encounter for adjustment or removal of breast implant

      2016 2017 2018 2019 Non-Billable/Non-Specific Code
    Applicable To
    • Encounter for elective implant exchange (different material) (different size)
    • Encounter removal of tissue expander without synchronous insertion of permanent implant
    Type 1 Excludes
    • complications of breast implant (T85.4-)
    • encounter for initial breast implant insertion for cosmetic breast augmentation (Z41.1)
    • encounter for breast reconstruction following mastectomy (Z42.1)

Diagnosis Index entries containing back-references to Z42.1:
  • Admission (for) - see also Encounter (for)
    • breast reconstruction following mastectomy Z42.1
  • Encounter (with health service) (for) Z76.89
    ICD-10-CM Diagnosis Code Z76.89

    Persons encountering health services in other specified circumstances

      2016 2017 2018 2019 Billable/Specific Code POA Exempt
    Applicable To
    • Persons encountering health services NOS
    • breast reconstruction following mastectomy Z42.1

ICD-10-CM Codes Adjacent To Z42.1
Z40.09 Encounter for prophylactic removal of other organ
Z40.8 Encounter for other prophylactic surgery
Z40.9 Encounter for prophylactic surgery, unspecified
Z41 Encounter for procedures for purposes other than remedying health state
Z41.1 Encounter for cosmetic surgery
Z41.2 Encounter for routine and ritual male circumcision
Z41.3 Encounter for ear piercing
Z41.8 Encounter for other procedures for purposes other than remedying health state
Z41.9 Encounter for procedure for purposes other than remedying health state, unspecified
Z42 Encounter for plastic and reconstructive surgery following medical procedure or healed injury
Z42.1 Encounter for breast reconstruction following mastectomy
Z42.8 Encounter for other plastic and reconstructive surgery following medical procedure or healed injury
Z43 Encounter for attention to artificial openings
Z43.0 Encounter for attention to tracheostomy
Z43.1 Encounter for attention to gastrostomy
Z43.2 Encounter for attention to ileostomy
Z43.3 Encounter for attention to colostomy
Z43.4 Encounter for attention to other artificial openings of digestive tract
Z43.5 Encounter for attention to cystostomy
Z43.6 Encounter for attention to other artificial openings of urinary tract
Z43.7 Encounter for attention to artificial vagina

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.