Coding Skin or Nipple-Sparing Mastectomy for Breast
A skin-sparing mastectomy can be performed as a simple, total, or modified radical mastectomy, which includes reconstruction.
A skin-sparing mastectomy removes all breast tissue and the nipple areolar complex and preserves breast skin to help facilitate reconstruction. It is performed with and without sentinel node biopsy or axillary lymph node dissection. A nipple-sparing mastectomy removes all breast tissue but preserves the nipple areolar complex and breast skin. An Areolar-sparing mastectomy breast preserves the areola and breast skin.
Always review the operative report to determine the intent of surgery, as it is being performed to preserve the skin or the nipple or consult with the surgeon on the procedure for clarification. In addition, review the surgeon’s consultation notes to verify the surgical plan. Per the STORE coding instructions, review the operative report or procedure note to code the appropriate surgical code. Code the most definitive surgical procedure for the primary site performed. Preserving the skin or nipple areola complex helps improve body image and cancer patient satisfaction. These types of procedures are not recommended if cancer involves the nipple or for Paget's disease.
Assign cancer-directed surgery codes for skin-sparing and nipple-sparing based on the date of diagnosis. For cases diagnosed in 2022 and prior, assign surgery code 30, subcutaneous mastectomy for nipple-sparing mastectomy, and 40-49, 75 for skin-sparing mastectomy. For 2023 diagnoses, assign A300 for a nipple-sparing mastectomy and A400-A490, A750 for a skin-sparing mastectomy, which removes the nipple and areolar complex. For cases diagnosed in 2025, the codes are more defined and have changed. Assign B400-B420 for nipple-sparing mastectomy procedures, B300-B320 for skin-sparing mastectomies. These procedures can be performed with the removal of the uninvolved or involved contralateral breast.
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