Version 2024

2024 ICD-10-CM Diagnosis Code Z40.01

Encounter for prophylactic removal of breast

ICD-10-CM Code:: Z40.01
ICD-10 Code for:: Encounter for prophylactic removal of breast
Is Billable?: Yes - Valid for Submission
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Code Information
Clinical Classification
Tabular List of Diseases and Injuries
Index to Diseases and Injuries References
Diagnostic Related Groups Mapping
Convert to ICD-9 Code
Patient Education
Other Codes Used Similar Conditions
Code History

Code Classification

Factors influencing health status and contact with health services
(Z00–Z99)
- Encounters for other specific health care
  (Z40-Z53)
  - Encounter for prophylactic surgery
    (Z40)

Z40.01 is a billable diagnosis code used to specify a medical diagnosis of encounter for prophylactic removal of breast. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.

Clinical Classification

Clinical Category is Encounter for prophylactic or other procedures
CCSR Category Code: FAC004
Inpatient Default CCSR: Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.
Outpatient Default CCSR: Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.

Index to Diseases and Injuries References

The following annotation back-references for this diagnosis code are found in the injuries and diseases index. The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10-CM code(s).

- Admission (for) - See Also: Encounter (for);
- - prophylactic (measure) - See Also: Encounter, prophylactic measures;
  - - organ removal - Z40.00
    - - breast - Z40.01

- Prophylactic
- - organ removal (for neoplasia management) - Z40.00
  - - breast - Z40.01

Z40.01 is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
600	NON-MALIGNANT BREAST DISORDERS WITH CC/MCC	09	1.0255
601	NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC	09	0.6226

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Convert Z40.01 to ICD-9-CM

ICD-9-CM Code: V50.41 - Prphylct orgn rmvl brst

Patient Education

Mastectomy

A mastectomy is surgery to remove a breast or part of a breast. It is usually done to treat breast cancer. Types of breast surgery include:

Total (simple) mastectomy - removal of breast tissue and nipple
Modified radical mastectomy - removal of the breast, most of the lymph nodes under the arm, and often the lining over the chest muscles
Lumpectomy - surgery to remove the tumor and a small amount of normal tissue around it

Which surgery you have depends on the stage of cancer, size of the tumor, size of the breast, and whether the lymph nodes are involved. Many women have breast reconstruction to rebuild the breast after a mastectomy.

Sometimes mastectomy is done to prevent breast cancer. Only high-risk patients have this type of surgery.

NIH: National Cancer Institute

[Learn More in MedlinePlus]

Breast Cancer Prevention (PDQ®)

Learn about breast cancer prevention, including risk factors and protective factors.
[Learn More in MedlinePlus]

Code History

FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.