ICD-10 Coding for Atypical Ductal Hyperplasia(N60.89)
Complete ICD-10-CM coding and documentation guide for Atypical Ductal Hyperplasia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Atypical Ductal Hyperplasia
Key Information: ICD-10 code for atypical ductal hyperplasia
Essential facts and insights about Atypical Ductal Hyperplasia
Primary ICD-10-CM Code for atypical ductal hyperplasia
Decision Criteria
clinical Criteria
- Biopsy confirms ADH without upgrade to DCIS or malignancy.
coding Criteria
- Do not use D05.10 unless DCIS is confirmed.
Applicable To
- Atypical ductal hyperplasia
Excludes
- Ductal carcinoma in situ (D05.-)
Clinical Validation Requirements
- Biopsy confirmation of atypical ductal hyperplasia
- Size ≤2 mm with ≤2 involved duct spaces
Code-Specific Risks
- Incorrectly coding as DCIS or malignancy
Coding Notes
- Ensure documentation specifies size, calcifications, and laterality.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Atypical Ductal Hyperplasia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N60.89.
Impact
Clinical: May lead to misclassification as DCIS., Regulatory: Increases risk of audit for incorrect coding., Financial: Potential for incorrect reimbursement.
Mitigation Strategy
Ensure pathology reports include size and extent details.
Impact
Reimbursement: Incorrect coding can lead to inappropriate DRG assignment., Compliance: May trigger audits for incorrect cancer coding., Data Quality: Misrepresents patient condition in medical records.
Mitigation Strategy
Use N60.89 for ADH unless DCIS is confirmed.
Impact
Incorrect coding of ADH as DCIS can lead to audits.
Mitigation Strategy
Ensure documentation clearly differentiates ADH from DCIS.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Atypical Ductal Hyperplasia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Atypical Ductal Hyperplasia
Use these documentation templates to ensure complete and accurate documentation for Atypical Ductal Hyperplasia. These templates include all required elements for proper coding and billing.
Biopsy-confirmed ADH
Specialty: PathologyRequired Elements
- Biopsy results
- Size and extent of lesion
- Immunohistochemical staining results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Atypical Ductal Hyperplasia? Ask your questions below.