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ICD-10-CM Code Z42.1
Encounter for breast reconstruction following mastectomy

BILLABLE
Billable Code
Billable codes are sufficient justification for admission to an acute care hospital when used a principal diagnosis.
POA Exempt
POA Exempt Code
The Center for Medicare & Medicaid Services (CMS) requires medical coders to indicate whether or not a condition was present at the time of admission, in order to properly assign MS-DRG codes. This "Present On Admission" (POA) indicator is recorded on CMS form 4010A.
Adult Only
Adult Only
Code is only used for patients 15 years old or older.
| ICD-10 from 2011 - 2016

Z42.1 is a billable ICD code used to specify a diagnosis of encounter for breast reconstruction following mastectomy. A 'billable code' is detailed enough to be used to specify a medical diagnosis.

POA Indicators on CMS form 4010A are as follows:

IndicatorMeaningCMS Will Pay CC/MCC DRG Costs
YDiagnosis was present at time of inpatient admissionYes
NDiagnosis was not present at time of inpatient admissionNo
UDocumentation insufficient to determine if the condition was present at the time of inpatient admission.No
WClinically undetermined. Provider unable to clinically determine whether the condition was present at the time of inpatient admission.Yes
1Exempt from POA reportingNo


Coding Notes for Z42.1 Info for medical coders on how to properly use this ICD-10 code

Code Type-1 Excludes:
Type-1 Excludes
Type-1 Excludes mean the conditions excluded are mutually exclusive and should never be coded together. Excludes 1 means "do not code here."
Deformity and disproportion of reconstructed breast - instead, use code N65.1-

MS-DRG Mapping

  • DRG Group #606-607 - Minor skin disorders with MCC.
  • DRG Group #606-607 - Minor skin disorders without MCC.

ICD-10-CM Alphabetical Index References for 'Z42.1 - Encounter for breast reconstruction following mastectomy'

The ICD-10-CM Alphabetical Index links the below-listed medical terms to the ICD code Z42.1. Click on any term below to browse the alphabetical index.

Equivalent ICD-9 Code GENERAL EQUIVALENCE MAPPINGS (GEM)

Encounter for breast reconstruction following mastectomy (exact match)

This is the official exact match mapping between ICD9 and ICD10, as provided by the General Equivalency mapping crosswalk. This means that in all cases where the ICD9 code V51.0 was previously used, Z42.1 is the appropriate modern ICD10 code.


Parent Code: Z42 - Encounter for plastic and reconstructive surgery following medical procedure or healed injury

** This Document Provided By ICD.Codes **
Source: http://icd.codes/icd10cm/Z421