| ICD-9-CM Diagnosis Code |
CPT-4 or HCPCS Procedure Code |
ICD-9-CM Procedure Code |
|
|---|---|---|---|
| Breast-specific codes | |||
| Infection, lymphadenitis | 611.0, 683.0, 996.69* |
||
| Incision/drainage†, ‡ | 19020, 38300, 38305 | 85.0, 85.91 | |
| Non-infectious wound complication† |
611.3, 875.0, 875.1, 879.0, 879.1 |
||
| Breast implant removal‡ | 11971, 19328 | 85.94, 85.96 | |
| General codes§ | |||
| Postoperative infection | 998.5–998.59 | ||
| Cellulitis† | 682.2, 682.3, 682.9∥ | ||
| Staphylococcus aureus‡,¶ | 041.1–041.19 | ||
| Incision/drainage†, ‡ | 10060, 10061, 10140–10180, 11000, 11001, 11005,# 11008,# 11040–11044, 20000, 20005, A6550, A6551, E2402, K0538 |
54.0,# 54.3,# 83.44– 83.49, 86.01, 86.04, 86.09, 86.22, 86.28 |
|
| Non-infectious wound complication† |
567.82,# 998.12, 998.3, 998.32, 998.83 |
CPT-4 indicates Current Procedural Terminology, 4th edition; HCPCS, Healthcare Common Procedure Coding System; ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification.
ICD-9-CM diagnosis code 996.69 was excluded if it was coded before a breast implant or flap reconstruction procedure or if it was on a claim with pathology code 88300 on the same day as a catheter removal (because 996.69 could be referring to an infection found on gross examination of the catheter).
Codes were used in combination with an ICD-9-CM diagnosis code for Staphylococcus aureus.
Codes were used in combination with an ICD-9-CM diagnosis code for cellulitis.
Excluded if occurred +/− 7 days of an SSI code that was specific to another type of device (ICD-9-CM 996.61–996.68, 999.31) while a catheter was in place.
Diagnosis code 682.9 codes for cellulitis and abscess at an unspecified site; it was used only if it was on the same claim line as a breast-specific incision/drainage code, on the same day as an implant removal, or coded by the patient’s breast surgeon.
A S. aureus diagnosis code associated with an incision/drainage code was only used if the incision/drainage code was breast-specific or coded by the patient’s breast surgeon.
Excluded if coded before a non-latissimus dorsi flap reconstruction procedure.