ICD-10 Coding for Bilateral Breast Pain(N64.4, G89.21)
Complete ICD-10-CM coding and documentation guide for Bilateral Breast Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Bilateral Breast Pain
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N64.4 | Mastodynia | Use for documented bilateral breast pain without underlying malignancy. |
|
| G89.21 | Chronic pain syndrome | Use when the encounter is primarily for pain management. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for bilateral breast pain
Essential facts and insights about Bilateral Breast Pain
Primary ICD-10-CM Codes for bilateral breast pain
Decision Criteria
clinical Criteria
- Bilateral breast pain documented without masses
documentation Criteria
- Specify 'bilateral' in documentation
Applicable To
- Breast pain
- Mastalgia
Excludes
- Pain due to malignant neoplasm of breast (C50.9)
Clinical Validation Requirements
- Documentation of bilateral breast pain
- Absence of palpable masses or suspicious imaging findings
Code-Specific Risks
- Ensure documentation specifies 'bilateral' to support coding.
Coding Notes
- Document the nature of the pain (cyclical, non-cyclical) and any associated symptoms.
G89.21 - Chronic pain syndrome
Use when the encounter is primarily for pain management.
Clinical Validation Requirements
- Chronic pain management focus
- Documentation of pain duration and management strategies
Coding Notes
Sequence G89.21 first if pain management is the primary reason for the encounter.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pain in thoracic spine
M54.6Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Other chest pain
R07.89Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Bilateral Breast Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N64.4.
Impact
Clinical: May lead to incorrect treatment focus., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Always document laterality, Review documentation for completeness
Impact
Reimbursement: Incorrect DRG assignment may occur., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use N64.4 for breast pain unless specified as musculoskeletal.
Impact
Incomplete documentation may lead to audit findings.
Mitigation Strategy
Ensure all required elements are documented.
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 Bilateral Breast Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Bilateral Breast Pain
Use these documentation templates to ensure complete and accurate documentation for Bilateral Breast Pain. These templates include all required elements for proper coding and billing.
Bilateral cyclical breast pain
Specialty: Primary CareRequired Elements
- Pain location
- Cyclical nature
- Associated symptoms
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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