Z42.1
✓ BillableEncounter for breast reconstruction following mastectomy
Factors influencing health status and contact with health services (Z00-Z99)
❌ Excludes1
directThese codes are mutually exclusive. Never code them together.
- • deformity and disproportion of reconstructed breast (N65.1-)
❌ Excludes1
inheritedRules inherited from parent codes in the hierarchy.
- • encounter for cosmetic plastic surgery (Z41.1)
- • encounter for plastic surgery for treatment of current injury - code to relevent injury
Clinical Description
ICD-10-CM code Z42.1 represents encounter for breast reconstruction following mastectomy. This code falls under the Factors influencing health status and contact with health services (Z00-Z99) classification. It is a billable/specific code valid for HIPAA-covered transactions as of October 1, 2025 (FY2026). This code can be used to indicate a diagnosis for reimbursement purposes on insurance claims.
This is a 5-character code at the 4th level of specificity. This is the most specific code available in this subcategory. Coders should note that Z42.1 has 3 Excludes1 restriction(s) — codes that cannot be reported together on the same claim.
Frequently Asked Questions
What is ICD-10 code Z42.1?
ICD-10-CM code Z42.1 is "Encounter for breast reconstruction following mastectomy". It belongs to the category: Factors influencing health status and contact with health services (Z00-Z99).
Is Z42.1 a billable ICD-10 code?
Yes, Z42.1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
What codes are excluded with Z42.1?
Z42.1 has 3 Excludes1 rule(s). These codes are mutually exclusive and cannot be coded together on the same claim.
Related Codes in Z42
Other codes in the same category that may be relevant for differential coding:
🧪 Validate Combinations
Add Z42.1 to the Excludes Checker to validate against your full code list.
Open in Checker →Code Information
Data Source
CMS ICD-10-CM 2026 Tabular List
Updated October 1, 2025 (FY2026)