Appendix 1. Diagnostic and Procedural Codes for and Immediate Reconstruction Definitions

Code Descriptions Code Description 174.* Malignant neoplasm of female breast Diagnosis 233.0 Carcinoma in situ of breast (ICD-9-CM Diagnosis Codes) 238.3 Neoplasm of uncertain behavior of breast 85.33 Unilateral subcutaneous mammectomy with synchronous implant 85.34 Other unilateral subcutaneous mammectomy 85.35 Bilateral subcutaneous mammectomy with synchronous implant 85.36 Other bilateral subcutaneous mammectomy 85.4 Mastectomy Mastectomy 85.41 Unilateral simple mastectomy (ICD-9-CM Procedure Codes) 85.42 Bilateral simple mastectomy 85.43 Unilateral extended simple mastectomy 85.44 Bilateral extended simple mastectomy 85.45 Unilateral radical mastectomy 85.46 Bilateral radical mastectomy 85.47 Unilateral extended radical mastectomy 85.48 Bilateral extended radical mastectomy 19301 Mastectomy, partial 19302 Mastectomy, partial, with axillary lymphadenectomy 19303 Mastectomy, simple, complete 19304 Mastectomy, subcutaneous 19305 Mastectomy, radical, including pectoral muscles, axillary Mastectomy lymph nodes (CPT Codes) 19306 Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes 19307 Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle 85.53 Unilateral 85.54 Bilateral breast implant 85.7* Total reconstruction of breast 85.82 Split-thickness graft to breast 85.83 Full-thickness graft to breast (ICD-9-CM Procedure Codes) 85.84 Pedicle graft to breast 85.85 Muscle flap graft to breast 85.89 Other mammoplasty 85.95 Insertion of breast tissue expander 11920 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin; 6.0 sq cm or less 11921 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin; 6.1 to 20.0 sq cm 11922 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin; > 20.0 sq cm 11970 Replacement of tissue expander with permanent prosthesis 11971 Removal of tissue expanders without insertion of prosthesis 15271 Application of a skin substitute graft, total wound surface area up to 100sq cm, first 25 sq cm or less wound surface area 15272 Application of a skin substitute graft, total wound surface area up to 100sq cm, each additional 25 cm wound surface area 15777 Implantation of biologic implant for soft tissue reinforcement 19316 19324 , augmentation; without implant Breast Reconstruction 19325 Mammaplasty, augmentation; with implant (CPT Codes) 19340 Immediate insertion of breast prosthesis following mastopexy, mastectomy, or in reconstruction 19350 Nipple/areola reconstruction 19357 Breast reconstruction, with tissue expander 19361 Breast reconstruction with latissimus dorsi flap, without implant 19364 Breast reconstruction with free flap 19366 Breast reconstruction with other technique 19367 Breast reconstruction with TRAM flap, single pedicle, including closure of donor site 19368 Breast reconstruction with TRAM flap, single pedicle, including closure of donor site, with microvascular anastomosis 19369 Breast reconstruction with TRAM flap, double pedicle, including closure of donor site 19396 Preparation of moulage for custom breast implant

Definitions Breast Cancer At least one of the following: 174, 174, 174.0, 174.1, 174.2, 174.3, 174.4, 174.5, 174.6, 174.8, 174.9, 233, 238.3 Mastectomy At least one of the following: 85.41, 85.42, 85.43, 85.44, 85.45, 85.46, 85.47, 85.48, 85.4, 85.33, 85.34, 85.35, 85.36, 19301, 19302, 19303, 19304, 19305, 19306, 19307 Immediate Breast At least one of the following concurrent with a mastectomy procedure code: Reconstruction 85.33, 85.35, 85.53, 85.54, 85.7, 85.7, 85.71, 85.72, 85.73, 85.74, 85.75, 85.76, 85.79, 85.82, 85.83, 85.84, 85.85, 85.89, 85.95, 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15777, 19316, 19324, 19325, 19340, 19350, 19357, 19361, 19364, 19366, 19367, 19368, 19369, 19396 Simple Mastectomy Any of the following: 85.41, 85.42, 85.43, 85.44, 19303, 19307 Radical Mastectomy Any of the following: 85.45, 85.46, 85.47, 85.48, 19305, 19306 Autologous Any of the following: vascularized tissue 85.71, 85.72, 85.73, 85.74, 85.75, 85.76, 85.82, 85.83, 85.84, 85.85, 19361, 19364, 19367, 19368, 19369 Tissue Any of the following: expander/implants 85.95, 85.53, 85.54, 85.33, 85.35, 19340, 19342, 19357 *All derivatives of specified code included