Appendix 1. Diagnostic and Procedural Codes for Mastectomy and Immediate Breast Reconstruction Definitions
Code Descriptions
Code Description Breast Cancer Diagnosis
(ICD-9-CM Diagnosis Codes)
174.* Malignant neoplasm of female breast 233.0 Carcinoma in situ of breast
238.3 Neoplasm of uncertain behavior of breast
Mastectomy
(ICD-9-CM Procedure Codes)
85.33 Unilateral subcutaneous mammectomy with synchronous implant
85.34 Other unilateral subcutaneous mammectomy
85.35 Bilateral subcutaneous mammectomy with synchronous implant
85.36 Other bilateral subcutaneous mammectomy 85.4 Mastectomy
85.41 Unilateral simple mastectomy 85.42 Bilateral simple mastectomy
85.43 Unilateral extended simple mastectomy 85.44 Bilateral extended simple mastectomy 85.45 Unilateral radical mastectomy
85.46 Bilateral radical mastectomy
85.47 Unilateral extended radical mastectomy 85.48 Bilateral extended radical mastectomy
Mastectomy (CPT Codes)
19301 Mastectomy, partial
19302 Mastectomy, partial, with axillary lymphadenectomy 19303 Mastectomy, simple, complete
19304 Mastectomy, subcutaneous
19305 Mastectomy, radical, including pectoral muscles, axillary lymph nodes
19306 Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes
19307 Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle
Breast Reconstruction (ICD-9-CM Procedure Codes)
85.53 Unilateral breast implant 85.54 Bilateral breast implant
85.7* Total reconstruction of breast 85.82 Split-thickness graft to breast 85.83 Full-thickness graft to breast 85.84 Pedicle graft to breast 85.85 Muscle flap graft to breast 85.89 Other mammoplasty
85.95 Insertion of breast tissue expander
Breast Reconstruction (CPT Codes)
11920 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin; 6.0 sq cm or less 11921 Tattooing, intradermal introduction of insoluble opaque
pigments to correct color defects of skin; 6.1 to 20.0 sq cm 11922 Tattooing, intradermal introduction of insoluble opaque
pigments to correct color defects of skin; > 20.0 sq cm 11970 Replacement of tissue expander with permanent prosthesis 11971 Removal of tissue expanders without insertion of prosthesis 15271 Application of a skin substitute graft, total wound surface area
up to 100sq cm, first 25 sq cm or less wound surface area 15272 Application of a skin substitute graft, total wound surface area
up to 100sq cm, each additional 25 cm wound surface area 15777 Implantation of biologic implant for soft tissue reinforcement 19316 Mastopexy
19324 Mammaplasty, augmentation; without implant 19325 Mammaplasty, augmentation; with implant 19340 Immediate insertion of breast prosthesis following
mastopexy, mastectomy, or in reconstruction 19350 Nipple/areola reconstruction
19357 Breast reconstruction, with tissue expander
19361 Breast reconstruction with latissimus dorsi flap, without implant
19364 Breast reconstruction with free flap
19366 Breast reconstruction with other technique
19367 Breast reconstruction with TRAM flap, single pedicle, including closure of donor site
19368 Breast reconstruction with TRAM flap, single pedicle, including closure of donor site, with microvascular anastomosis
19369 Breast reconstruction with TRAM flap, double pedicle, including closure of donor site
19396 Preparation of moulage for custom breast implant
Definitions
Breast Cancer At least one of the following:
174, 174, 174.0, 174.1, 174.2, 174.3, 174.4, 174.5, 174.6, 174.8, 174.9, 233, 238.3
Mastectomy At least one of the following:
85.41, 85.42, 85.43, 85.44, 85.45, 85.46, 85.47, 85.48, 85.4, 85.33, 85.34, 85.35, 85.36, 19301, 19302, 19303, 19304, 19305, 19306, 19307
Immediate Breast Reconstruction
At least one of the following concurrent with a mastectomy procedure code:
85.33, 85.35, 85.53, 85.54, 85.7, 85.7, 85.71, 85.72, 85.73, 85.74, 85.75, 85.76, 85.79, 85.82, 85.83, 85.84, 85.85, 85.89, 85.95, 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15777, 19316, 19324, 19325, 19340, 19350, 19357, 19361, 19364, 19366, 19367, 19368, 19369, 19396
Simple Mastectomy Any of the following:
85.41, 85.42, 85.43, 85.44, 19303, 19307 Radical Mastectomy Any of the following:
85.45, 85.46, 85.47, 85.48, 19305, 19306 Autologous
vascularized tissue
Any of the following:
85.71, 85.72, 85.73, 85.74, 85.75, 85.76, 85.82, 85.83, 85.84, 85.85, 19361, 19364, 19367, 19368, 19369
Tissue
expander/implants
Any of the following:
85.95, 85.53, 85.54, 85.33, 85.35, 19340, 19342, 19357
*All derivatives of specified code included
