Nip Lumpectomy Denials With a Z Code
Question: The surgeon performed a breast lumpectomy, but it seems like the only ICD-10-CM codes I’m coming across are Z codes, which suggest a complete removal or acquired absence of the breasts. What is the correct code for a lumpectomy? Should I use an N63.- code? RCI Subscriber Answer: No, in this situation, you should not use an N63.- (Unspecified lump in breast) code. While these codes permit the addition of suitable characters for the right (1 as the 4th character) and left (2 as the 4th character) breasts, and the 5th characters for the relevant quadrant, they don’t fully capture the patient’s complete situation or experience. Instead, you will choose an appropriate code from Z90.1- (Acquired absence of breast and nipple). You can use these codes because next to the ICD-10-CM Alphabetic Index entry for “Absence (of) (organ or part),” you’ll see the words “complete or partial.” This implies that the entry under “Absence for breast(s) (and nipple(s)) (acquired),” covers both full and partial mastectomies and lumpectomies. The procedure can be further detailed by appending a 4th character to the Z90.1- code to denote the breast(s) involved. However, there are no options for a 5th character to indicate the affected quadrant. Lindsey Bush, BA, MA, CPC, Production Editor, AAPC
