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Z90.12 ICD-10-CM Code: Acquired absence of left breast and nipple

Compare with another code for Z90.12Check this code on a claim

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 1 Excludes1 · 1 Excludes2 · 1 code-also instruction

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too, and is marked with where it comes from.

Excludes1from Z90Not reported with this code unless documented as unrelated
  • congenital absence - see Alphabetical Index
Code alsofrom Z77-Z99May be needed with this code
  • any follow-up examination (Z08-Z09)
Excludes2from Z90Not included here; may be reported together
  • postprocedural absence of endocrine glands (E89.-)
Includesfrom Z90What Z90 covers
  • postprocedural or post-traumatic loss of body part NEC

Where it sits Source: CMS/NCHS

Under:Chapter 21: Factors Influencing Health Status and Contact with Health ServicesZ77-Z99 Persons with potential health hazards related to family and personal history and certain conditions influencing health statusZ90 Acquired absence of organs, not elsewhere classifiedZ90.1 Acquired absence of breast and nipple

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 951 — OTHER FACTORS INFLUENCING HEALTH STATUS (MDC 23)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for Z90.12 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on Z90.12 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • postprocedural or post-traumatic loss of body part NEC

Source: inherited from Z90

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

  • congenital absence - see Alphabetical Index

Source: inherited from Z90

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from Z90

Code Also

Additional codes that may be required to fully describe the encounter.

  • any follow-up examination (Z08-Z09)

Source: inherited from Z77-Z99

Coder workflow for Z90.12

MedCoder structured workflow — derived from this code’s own official record

Before you code Z90.12

  1. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: left). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

    ReviewZ90.11 · right, Z90.10 · unspecified

    Guide: Laterality coding →

  2. Confirm the reason for the encounter this Z code records: a status — a condition, carrier state or sequela that may affect care, distinct from a current complication of it. Check whether the code may be reported as first-listed or principal — some Z codes are limited to one position — and do not report a history or status code for a condition documented as current. Z code categories and their reporting positions (Guidelines I.C.21.c.3, I.C.21.c.15).

    Guide: Status codes (Z codes) →

  3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with Z90.12. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in Z90.12’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.
  2. Is the side documented?
    Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
    No → Use the unspecified-side code only when the record states no side; a query is the alternative.

    ReviewZ90.11 · right, Z90.10 · unspecified

Consider Z90.12. Then review the Code Also note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Laterality
Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).
The reason for the encounter
Whether the code records the encounter’s purpose, a status, or a history — and whether it may be first-listed (Guidelines I.C.21.c).

Official instructions as workflow

  • Excludes1 — check before selecting Z90.12(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with Z90.12: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of Z90.12(1 note)

    Coding workflow: The conditions named in this note are not included in Z90.12. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareE89

    See the official tabular notes · Guidelines I.A.12.b

  • Code Also — related condition(1 note)

    Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.

    See the official tabular notes · Guidelines I.A.17

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition Z90.12 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

Documentation: The record documents the condition on one side only.

Coding question: Which code in this family applies?

Path: Select the sibling code for the documented side.

Reason: Laterality is assigned from the documented side; the unspecified-side code is for records that state no side (Guidelines I.B.13).

ReviewZ90.11 · right, Z90.10 · unspecified

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse Z90.12 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of Z90.12 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • Z90.10— Specificity relationship (Review)

    Overlapping diagnoses in the same category.

    Overlapping codes in the same category — the documentation decides which is the more specific fit.

    What moves you there: A record that documents no more than “Acquired absence of unspecified breast and nipple” takes Z90.10; specificity in the record moves it back here.

    Full comparison: Z90.12 vs Z90.10 →

  • Z90.11— Laterality relationship (Review)

    Same condition; these differ only in which side is documented.

    The same condition with a different side named (the opposite side, both sides, or none); the documented side decides, and a bilateral code, where one exists, replaces the pair when both sides are documented.

    What moves you there: A documented right side moves the case to Z90.11.

    Full comparison: Z90.12 vs Z90.11 →

  • E89— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of postprocedural absence of endocrine glands adds E89; it is not part of this code and both may be reported when both are documented.

    Full comparison: Z90.12 vs E89 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Acquired absence of left breast and nipple is a billable ICD-10-CM diagnosis code (Z90.12).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)

Z88 Allergy status to drugs, medicaments and biological substances Except: Z88.9, Allergy status to unspecified drugs, medicaments and biological substances status Z89 Acquired absence of limb Z90 Acquired absence of organs, not elsewhere classified Z91.0- Allergy status, other than to drugs and biological substances Z92.82 Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to a current facility

Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)

Z99 Dependence on enabling machines and devices, not elsewhere classified Note: Categories Z89-Z90 and Z93-Z99 are for use only if there are no complications or malfunctions of the organ or tissue replaced, the amputation site or the equipment on which the patient is dependent.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. Laterality is coded in this family. Confirm the documented side matches the code — the opposite-side siblings are in the relationships section. See the opposite-side sibling codes
  2. 1 Code Also note — a second code may apply; the guidelines leave its sequencing to the circumstances of the encounter. See the Code Also notes
  3. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  4. 1 Excludes2 entry — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name Z90.12 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes2 note: M95 — Other acquired deformities of musculoskeletal system and connective tissue (via Z90.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Use Additional Code instruction: Z08 — Encounter for follow-up examination after completed treatment for malignant neoplasm (via Z90.-).

These codes instruct coders to additionally report this code when it applies.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 1 MS-DRG: DRG 951 (MDC 23).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):FAC022 — Acquired absence of limb or organ (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same condition, different side

Same title, differing only in which side of the body it names: right, left, bilateral or unspecified.

Z90.10 — Acquired absence of unspecified breast and nipple (unspecified)Compare Z90.12 vs Z90.10 →, Z90.11 — Acquired absence of right breast and nipple (right)Compare Z90.12 vs Z90.11 →

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Acquired absence of limb or organ).

Z89.619 — Acquired absence of unspecified leg above knee, Z89.621 — Acquired absence of right hip joint, Z89.622 — Acquired absence of left hip joint, Z89.629 — Acquired absence of unspecified hip joint, Z89.9 — Acquired absence of limb, unspecified, Z90.01 — Acquired absence of eye, Z90.02 — Acquired absence of larynx, Z90.09 — Acquired absence of other part of head and neck, Z90.10 — Acquired absence of unspecified breast and nipple, Z90.11 — Acquired absence of right breast and nipple, Z90.13 — Acquired absence of bilateral breasts and nipples, Z90.2 — Acquired absence of lung [part of], Z90.3 — Acquired absence of stomach [part of], Z90.410 — Acquired total absence of pancreas, Z90.411 — Acquired partial absence of pancreas, Z90.49 — Acquired absence of other specified parts of digestive tract, Z90.5 — Acquired absence of kidney, Z90.6 — Acquired absence of other parts of urinary tract, Z90.710 — Acquired absence of both cervix and uterus, Z90.711 — Acquired absence of uterus with remaining cervical stump, +50 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Status”, “Absence”; these codes share that main term but sit in a different category of the Tabular List.

Z89.41 — Acquired absence of great toe (toe, great), Z89.42 — Acquired absence of other toe(s) (toe), Z89.43 — Acquired absence of foot (foot), Z89.44 — Acquired absence of ankle (ankle), Z89.51 — Acquired absence of leg below knee (leg, below knee), Z89.52 — Acquired absence of knee (knee), Z89.61 — Acquired absence of leg above knee (leg), Z89.619 — Acquired absence of unspecified leg above knee (extremity, lower), Z89.62 — Acquired absence of hip (hip), Z89.9 — Acquired absence of limb, unspecified (extremity), Z92.82 — Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility (tPAadministration in a different facility within the last 24 hours prior to admission to current facility), Z93.0 — Tracheostomy status (tracheostomy), Z93.1 — Gastrostomy status (gastrostomy), Z93.2 — Ileostomy status (ileostomy), Z93.3 — Colostomy status (colostomy), Z93.4 — Other artificial openings of gastrointestinal tract status (enterostomy), Z93.50 — Unspecified cystostomy status (cystostomy), Z93.51 — Cutaneous-vesicostomy status (cystostomy, cutaneous), Z93.52 — Appendico-vesicostomy status (cystostomy, appendico-vesicostomy), Z93.59 — Other cystostomy status (cystostomy, specified NEC), +254 more

Contextual Map

Every relationship of Z90.12 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run Z90.12 with these 2 related codes in Claim Check

Hierarchy

Referenced by Excludes2 notes

Referenced by Use Additional Code instructions

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 23 — Factors Influencing Health Status and Other Contacts with Health Services[MDC crossing]: “Factors Influencing Health Status and Other Contacts with Health Services — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1,258 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Nearest codes (30)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder-derived relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder editorial explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "Z90.12 — Acquired absence of left breast and nipple." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/z90.12-acquired-absence-of-left-breast-and-nipple

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Acquired absence of left breast and nipple

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to Z90.12 in its code family, with their registry titles.

View all codes in the Z90 family