ICD-10 Coding for Breast Exam(C50.911, N63.0)
Complete ICD-10-CM coding and documentation guide for Breast Exam. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Exam
C50Primary Range
Malignant neoplasm of breast
Primary range for coding breast cancer, requiring specification of laterality, quadrant, and sex.
Abnormal and inconclusive findings on diagnostic imaging of breast
Used for coding abnormal findings in breast imaging.
Encounter for screening mammogram for malignant neoplasm of breast
Used for coding screening mammograms in asymptomatic patients.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C50.911 | Malignant neoplasm of unspecified site of right female breast | Use when a malignant neoplasm is confirmed in the right breast of a female, and specific site is unspecified. |
|
| N63.0 | Unspecified lump in unspecified breast | Use when a breast lump is detected but not further specified. |
|
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 breast exam
Essential facts and insights about Breast Exam
Primary ICD-10-CM Codes for breast exam
Decision Criteria
clinical Criteria
- Confirmed diagnosis of breast cancer in the right breast
Applicable To
- Breast cancer, female, right
Excludes
- Benign neoplasms of breast
Clinical Validation Requirements
- Histological confirmation of malignancy
- Imaging showing mass in right breast
Code-Specific Risks
- Risk of using unspecified site when specific site is known
Coding Notes
- Ensure laterality is specified when possible.
N63.0 - Unspecified lump in unspecified breast
Use when a breast lump is detected but not further specified.
Applicable To
- Breast lump, NOS
Excludes
- Malignant neoplasm of breast
Clinical Validation Requirements
- Physical examination finding of a lump in the breast
Coding Notes
Consider further diagnostic workup to specify the lump.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Personal history of malignant neoplasm of breast
Z85.3Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Breast Exam to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C50.911.
Impact
Clinical: May lead to inappropriate follow-up recommendations., Regulatory: Non-compliance with radiology reporting standards., Financial: Potential for claim denials due to incomplete documentation.
Mitigation Strategy
Ensure all imaging reports include BI-RADS category., Use standardized reporting templates.
Impact
Reimbursement: May lead to reduced reimbursement due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Poor data quality affecting patient records.
Mitigation Strategy
Always document and code the specific site and laterality of the breast condition.
Impact
Coding breast conditions without specifying laterality increases audit risk.
Mitigation Strategy
Always document and code the specific side of the 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 Exam, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Breast Exam
Use these documentation templates to ensure complete and accurate documentation for Breast Exam. These templates include all required elements for proper coding and billing.
Routine Screening Mammogram
Specialty: RadiologyRequired Elements
- Patient demographics
- Indication for exam
- Imaging findings
- BI-RADS category
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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