2027 ICD-10-CM Diagnosis Code Z40.01Encounter for prophylactic removal of breast
Z40.01 is a billable ICD-10-CM diagnosis code for encounter for prophylactic removal of breast. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 600 through 601. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Encounter for prophylactic or other procedures.
Code Identity
Code Classification
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to Z40.01: its own notes plus those printed at Z40.0, Z40, block Z40-Z53, and Chapter 21. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Use Additional Code
Add a second code, after this one, to fully describe the condition.
Notes
General instructions on how these codes are used.
- Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
- (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
- (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name Z40.01, its category, or a range that includes it.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Admission (for) See Also: Encounter (for);
prophylactic (measure) See Also: Encounter, prophylactic measures;
breast Z40.01
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Mastectomy
A mastectomy is surgery to remove part or all of the breast. It's usually done to treat breast cancer by removing the cancer. A mastectomy may be the first treatment option for some types of breast cancer or done after chemotherapy for other types.
The full article covers:
- What is a mastectomy?
- What are the different types of mastectomies?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert Z40.01 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About Z40.01Overview
What is the ICD-10 code for encounter for prophylactic removal of breast?
The ICD-10-CM code for encounter for prophylactic removal of breast is Z40.01 (sometimes written as Z4001). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is Z40.01 a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report encounter for prophylactic removal of breast on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does Z40.01 group to?
When encounter for prophylactic removal of breast is the principal diagnosis on an inpatient stay, it groups to MS-DRG 600, 601, with relative weights from 0.6014 to 0.9971 depending on complications. Higher weights mean higher Medicare reimbursement.
Can Z40.01 be reported with a code from Z52?
Not as a rule. The Excludes1 note at Z40, which applies to Z40.01, lists "organ donations (Z52.-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
