Wiki Prophylactic mastectomy

[jsass5]

Are there any ICD-10 codes that can be used for a prophylactic mastectomy if it is strictly preventative? We are getting denials from our local BC when using Z codes.

 

[sls314]

Are there any ICD-10 codes that can be used for a prophylactic mastectomy if it is strictly preventative? We are getting denials from our local BC when using Z codes.

Which Z codes are you using?

Z40.01 is Encounter for prophylactic removal of breast. I'd expect that there would be some supporting codes to show why the prophylactic removal was being performed due to that patient's increased risk.

For example, as applicable to the specific patient, you might see Z15.01 Genetic susceptibility to malignant neoplasm breast and/or Z80.3 Family history of malignant neoplasm of breast

Also, many insurers will want a prior authorization for the procedure, so if your local BC requires it make sure you're obtaining that authorization as well.

Is this for BCBS Idaho? Here's a link to a Medical Policy on Risk-Reducing Mastectomy that I found on the BCBS Idaho website: https://providers.bcidaho.com/medical-management/medical-policies/sur/mp_70109.page