I97.2

I97.2: Postmastectomy lymphedema syndrome

Billable / specific codeICD-10-CM

I97.2 is a billable, specific ICD-10-CM code for postmastectomy lymphedema syndrome. It is valid for submission on a claim.

Check I97.2 with the rest of the claim: free scrubber

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Elephantiasis due to mastectomy
Obliteration of lymphatic vessels

Excludes2 inherited from the categories above I97.2

Not part of this code, but both may be coded when both are present.

Written on I97: Intraoperative and postprocedural complications and disorders of circulatory system, not elsewhere classified

postprocedural shock (T81.1-)

Other codes that can never be billed with I97.2

Their own Excludes1 notes name this code, so the conflict is not listed above.

I89.0Lymphedema, not elsewhere classified

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

I97.2 is named in 7 Medicare coverage policies: 6 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which one applies depends on your Medicare contractor.

A57067Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
A52478External Breast Prostheses - Policy Article
A53057Billing and Coding: Home Health Occupational Therapy
A53058Billing and Coding: Home Health Physical Therapy

Alphabetic index entries that lead here

Postmastectomy lymphedema(syndrome)
Lymphedema›postmastectomy
Syndrome›postmastectomy lymphedema
Complication›surgical procedure›postmastectomy lymphedema syndrome
Edema, edematous›lymphatic›due to mastectomy
Elephantiasis›due to›mastectomy
Elephantiasis›lymphatic vessel›due to mastectomy
Elephantiasis›surgical›postmastectomy
Lymphedema›surgical NEC›postmastectomy(syndrome)
Obliteration›lymphatic vessel›due to mastectomy
Complication›circulatory system›postprocedural›lymphedema after mastectomy
Complication›surgical procedure›elephantiasis or lymphedema›postmastectomy

Code history

Unchanged in every release from FY2024 to FY2027.