ICD-10 Coding for Breast Discomfort(N64.4, N64.59)
Complete ICD-10-CM coding and documentation guide for Breast Discomfort. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Discomfort
N60-N64Primary Range
Disorders of breast
This range includes codes for various breast disorders, including mastodynia and other breast symptoms.
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 when breast pain is cyclical and correlates with the menstrual cycle. |
|
| N64.59 | Other signs and symptoms in breast | Use for non-specific or non-cyclical breast pain. |
|
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 cyclical breast pain
Essential facts and insights about Breast Discomfort
Primary ICD-10-CM Codes for breast discomfort
Decision Criteria
clinical Criteria
- Pain correlates with menstrual cycle.
documentation Criteria
- Normal imaging results documented.
Applicable To
- Cyclical breast pain
Excludes
- Non-cyclical breast pain (N64.59)
Clinical Validation Requirements
- Menstrual cycle correlation
- Normal imaging results
Code-Specific Risks
- Incorrect use for non-cyclical pain
Coding Notes
- Ensure documentation specifies the cyclical nature of the pain.
N64.59 - Other signs and symptoms in breast
Use for non-specific or non-cyclical breast pain.
Applicable To
- Non-specific breast tenderness
Excludes
- Cyclical breast pain (N64.4)
Clinical Validation Requirements
- Non-cyclical pain
- Normal imaging results
Coding Notes
Ensure documentation specifies the non-cyclical nature of the pain.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Epigastric pain
R10.13Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Breast Discomfort to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N64.4.
Impact
Clinical: Inaccurate diagnosis and treatment., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always document the cyclical or non-cyclical nature of the pain.
Impact
Reimbursement: Claims may be denied due to incorrect coding., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on breast pain prevalence.
Mitigation Strategy
Ensure documentation specifies the cyclical nature of the pain.
Impact
Inaccurate documentation of pain type can lead to audit findings.
Mitigation Strategy
Ensure thorough documentation of pain characteristics.
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 Discomfort, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Breast Discomfort
Use these documentation templates to ensure complete and accurate documentation for Breast Discomfort. These templates include all required elements for proper coding and billing.
Cyclical Breast Pain
Specialty: GynecologyRequired Elements
- Pain correlation with menstrual cycle
- Normal imaging results
- Severity scale
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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