2025 ICD-10-CM code Z40.0
Encounter for prophylactic surgery for risk factors related to malignant neoplasms. Admission for prophylactic organ removal.
Medical necessity must be established based on evidence of increased risk of developing a specific malignancy, along with professional guidelines for prophylactic intervention in such cases.
The physician is responsible for determining the patient's eligibility for prophylactic surgery, performing the procedure, and providing appropriate post-operative care.
- Factors influencing health status and contact with health services (Z00-Z99)
- Z40: Encounter for prophylactic surgery
In simple words: This code is used when a person has surgery to prevent cancer because they have a high risk of developing it.
This code is used for encounters for prophylactic surgery to reduce the risk of developing a malignant neoplasm (cancer). It covers admissions for prophylactic removal of an organ.An additional code should be used to identify the specific risk factor.
Example 1: A patient with a strong family history of breast cancer and a positive BRCA gene test undergoes a prophylactic mastectomy., A patient with familial adenomatous polyposis (FAP), a condition that significantly increases the risk of colon cancer, undergoes a prophylactic colectomy., A patient with a history of multiple benign breast biopsies showing atypical hyperplasia undergoes a prophylactic bilateral mastectomy.
Documentation should include the patient's risk factors for malignancy, the rationale for prophylactic surgery, details of the surgical procedure performed, and any associated diagnoses.
- Specialties:Oncology, General Surgery, and other surgical specialties related to the specific organ removed.
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center