I97.2 — Postmastectomy lymphedema syndrome
I97.2 is a billable, specific ICD-10-CM code for postmastectomy lymphedema syndrome. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Elephantiasis due to mastectomy
- Obliteration of lymphatic vessels
Other codes that can never be billed with I97.2
These codes carry an Excludes1 note pointing at I97.2. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading I97.2 alone.
- I89.0Lymphedema, not elsewhere classified
Risk adjustment
I97.2 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move 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 of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- 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
How I97.2 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to I97.2.
- 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
Related codes at this level
Codes that share I97. If I97.2 is not quite right, the correct code is usually one of these.
- I97.0Postcardiotomy syndrome
- I97.1Other postprocedural cardiac functional disturbances
- I97.3Postprocedural hypertension
- I97.4Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating a procedure
- I97.5Accidental puncture and laceration of a circulatory system organ or structure during a procedure
- I97.6Postprocedural hemorrhage, hematoma and seroma of a circulatory system organ or structure following a procedure
- I97.7Intraoperative cardiac functional disturbances
- I97.8Other intraoperative and postprocedural complications and disorders of the circulatory system, not elsewhere classified
Questions about I97.2
- Is I97.2 a billable ICD-10-CM code?
- Yes. I97.2 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does I97.2 sit in the tabular list?
- Diseases of the circulatory system (I00-I99), in the block Other and unspecified disorders of the circulatory system (I95-I99).