ICD-10 Diagnosis Code Z42.1

Encounter for breast reconstruction following mastectomy

Diagnosis Code Z42.1

ICD-10: Z42.1
Short Description: Encounter for breast reconstruction following mastectomy
Long Description: Encounter for breast reconstruction following mastectomy
This is the 2017 version of the ICD-10-CM diagnosis code Z42.1

Valid for Submission
The code Z42.1 is valid for submission for HIPAA-covered transactions.

Code Classification
  • Factors influencing health status and contact with health services (Z00–Z99)
    • Encounters for other specific health care (Z40-Z53)
      • Encntr for plast/recnst surg fol med proc or healed injury (Z42)

Information for Medical Professionals


Code Edits
The following edits are applicable to this code:
Adult diagnoses Additional informationCallout TooltipAdult diagnoses
Adult. Age range is 15–124 years inclusive (e.g., senile delirium, mature cataract).


Diagnostic Related Groups
The diagnosis code Z42.1 is grouped in the following Diagnostic Related Group(s) (MS-DRG v33.0)

  • MINOR SKIN DISORDERS WITH MCC 606
  • MINOR SKIN DISORDERS WITHOUT MCC 607

Convert to ICD-9 Additional informationCallout TooltipGeneral Equivalence Map
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
  • V51.0 - Brst reconst fol mastect

Present on Admission (POA) Additional informationCallout TooltipPresent on Admission
The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement.

The code Z42.1 is exempt from POA reporting.

Index of Diseases and Injuries
References found for the code Z42.1 in the Index of Diseases and Injuries:


Information for Patients


Breast Reconstruction

If you need a mastectomy, you have a choice about whether or not to have surgery to rebuild the shape of the breast. Instead of breast reconstruction, you could choose to wear a breast form that replaces the breast, wear padding inside your bra, or do nothing. All of these options have pros and cons. What is right for one woman may not be right for another.

Breast reconstruction may be done at the same time as the mastectomy, or it may be done later on. If radiation therapy is part of the treatment plan, your doctor may suggest waiting until after radiation therapy.

If you're thinking about breast reconstruction, talk to a plastic surgeon before the mastectomy, even if you plan to have your reconstruction later on.

A surgeon can reconstruct the breast in many ways. Some women choose to have breast implants, which are filled with saline or silicone gel. Another method uses tissue taken from another part of your body. The plastic surgeon can take skin, muscle, and fat from your lower abdomen, back, or buttocks.

The type of reconstruction that is best for you depends on your age, body type, and the type of cancer surgery that you had. A plastic surgeon can help you decide.

NIH: National Cancer Institute

  • Breast reconstruction - implants (Medical Encyclopedia)
  • Breast reconstruction - natural tissue (Medical Encyclopedia)


[Read More]
Previous Code
Previous Code Z42
Next Code
Z42.8 Next Code