ICD-10 Coding for Breast Cyst(N60.01, N60.02, N60.09, N60.11)
Complete ICD-10-CM coding and documentation guide for Breast Cyst. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Cyst
N60.0-N60.1Primary Range
Benign Mammary Dysplasia
This range includes codes for various types of breast cysts, including solitary and diffuse cystic mastopathy.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N60.01 | Solitary cyst of right breast | Use when a solitary cyst is confirmed in the right breast. |
|
| N60.02 | Solitary cyst of left breast | Use when a solitary cyst is confirmed in the left breast. |
|
| N60.09 | Solitary cyst of unspecified breast | Use only if documentation lacks laterality. |
|
| N60.11 | Diffuse cystic mastopathy of right breast | Use when diffuse cystic changes are confirmed in the right breast. |
|
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: How to code a breast cyst?
Essential facts and insights about Breast Cyst
Primary ICD-10-CM Codes for breast cyst
Decision Criteria
clinical Criteria
- Presence of a solitary, anechoic cyst on ultrasound
Applicable To
- Unilateral right breast cyst
Excludes
- Diffuse cystic mastopathy (N60.11)
Clinical Validation Requirements
- Ultrasound confirmation of anechoic cyst
- Physical exam noting solitary, mobile mass
Code-Specific Risks
- Incorrect laterality documentation
Coding Notes
- Ensure laterality is documented to avoid unspecified coding.
N60.02 - Solitary cyst of left breast
Use when a solitary cyst is confirmed in the left breast.
Applicable To
- Unilateral left breast cyst
Excludes
- Diffuse cystic mastopathy (N60.12)
Clinical Validation Requirements
- Ultrasound confirmation of anechoic cyst
- Physical exam noting solitary, mobile mass
Coding Notes
Ensure laterality is documented to avoid unspecified coding.
N60.09 - Solitary cyst of unspecified breast
Use only if documentation lacks laterality.
Applicable To
- Unspecified breast cyst
Excludes
- Diffuse cystic mastopathy (N60.19)
Clinical Validation Requirements
- Lack of specific laterality in documentation
Coding Notes
Avoid using unless absolutely necessary due to lack of specificity.
N60.11 - Diffuse cystic mastopathy of right breast
Use when diffuse cystic changes are confirmed in the right breast.
Applicable To
- Multiple cysts in right breast
Excludes
- Solitary cyst (N60.01)
Clinical Validation Requirements
- Mammography showing clusters of microcysts
Coding Notes
Ensure documentation specifies 'diffuse' to differentiate from solitary cysts.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Abnormal mammogram
R92.8Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Breast Cyst to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N60.01.
Impact
Clinical: May lead to inappropriate treatment decisions, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials or payment delays
Mitigation Strategy
Ensure imaging reports are reviewed and documented, Educate staff on the importance of specifying cyst type
Impact
Reimbursement: Claims may be denied due to unspecified laterality, Compliance: Non-compliance with Medicare requirements, Data Quality: Inaccurate data collection and reporting
Mitigation Strategy
Code N60.11 + N60.12 for bilateral cases
Impact
Reimbursement: Incorrect billing leading to claim denials, Compliance: Violation of CPT coding guidelines, Data Quality: Misrepresentation of procedure performed
Mitigation Strategy
Use 19000-50 for bilateral aspiration
Impact
High denial rate for claims with unspecified laterality.
Mitigation Strategy
Always document and code the specific breast affected.
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 Breast Cyst, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Breast Cyst
Use these documentation templates to ensure complete and accurate documentation for Breast Cyst. These templates include all required elements for proper coding and billing.
Breast Cyst Diagnosis
Specialty: RadiologyRequired Elements
- Laterality
- Cyst Characteristics
- Correlation with Symptoms
- Recommendation
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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