Z42.1 vs Z48.3

Does anyone know where it is documented that when a patient has a mastectomy & reconstruction (due to breast cancer) during the same surgery that the Z42.1 code should be used instead Z48.3?


  • Is this code no longer acceptable as primary (Z42.1) 1/1/20 when PDGM update takes place?

  • Z48.3 is the code to use for aftercare following reconstructive surgery following a mastectomy due to breast cancer. Z42.1 isn't currently listed as an acceptable primary diagnosis under PDGM.

  • thank you for your input. Was Z42.1 coded prior to PDGM going into effect? I remember reading in a past Coding Pro to code Z42.1 use for the above situation.

  • I don't know -- I searched back issues of Dx Coding Pro and I couldn't find any mention of using Z42.1 in this situation. But things do have a way of evolving as we get new guidance over the years.

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