ICD-10 Coding for Breast Lump(N63.2, N63.10)
Complete ICD-10-CM coding and documentation guide for Breast Lump. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Lump
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N63.2 | Unspecified lump in the left breast | Use when a lump is identified in the left breast and the specific quadrant is not documented. |
|
| N63.10 | Unspecified lump in the right breast, unspecified quadrant | Use when a lump is identified in the right breast and the specific quadrant is not documented. |
|
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 lump
Essential facts and insights about Breast Lump
Primary ICD-10-CM Codes for breast lump
Decision Criteria
documentation Criteria
- Presence of a lump in the left breast without quadrant specification
Applicable To
- Lump in left breast, unspecified quadrant
Excludes
- Malignant neoplasm of breast (C50.-)
Clinical Validation Requirements
- Physical examination findings
- Imaging results (e.g., mammography, ultrasound)
Code-Specific Risks
- Risk of under-coding if quadrant is specified but not documented
Coding Notes
- Ensure laterality is documented to avoid unspecified coding.
N63.10 - Unspecified lump in the right breast, unspecified quadrant
Use when a lump is identified in the right breast and the specific quadrant is not documented.
Applicable To
- Lump in right breast, unspecified quadrant
Excludes
- Malignant neoplasm of breast (C50.-)
Clinical Validation Requirements
- Physical examination findings
- Imaging results (e.g., mammography, ultrasound)
Coding Notes
Ensure laterality is documented to avoid unspecified coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for other screening mammography
Z12.39Differential 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 Breast Lump to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N63.2.
Impact
Clinical: May lead to incorrect treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential for reduced reimbursement due to unspecified coding.
Mitigation Strategy
Use templates that prompt for quadrant documentation., Educate providers on the importance of specific documentation.
Impact
Reimbursement: May lead to lower reimbursement rates due to lack of specificity., Compliance: Non-compliance with coding guidelines requiring specificity., Data Quality: Reduces the accuracy of clinical data for research and analysis.
Mitigation Strategy
Always document and code the specific quadrant when available.
Impact
Audits may focus on the use of unspecified codes when specific information is available.
Mitigation Strategy
Ensure all documentation includes laterality and quadrant details.
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 Lump, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Breast Lump
Use these documentation templates to ensure complete and accurate documentation for Breast Lump. These templates include all required elements for proper coding and billing.
Breast Lump Evaluation
Specialty: RadiologyRequired Elements
- Location: Right/Left/Bilateral
- Size: ___ cm
- Consistency: Mobile/Fixed
- Skin changes: Erythema/Peau d'orange/Normal
- Imaging correlation: Mammogram BIRADS __
- Plan: FNA/core biopsy/excisional biopsy
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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