ICD-10 Coding for Cystic Mastopathy(N60.11, N60.12, N60.19)
Complete ICD-10-CM coding and documentation guide for Cystic Mastopathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Cystic Mastopathy
N60.0-N60.9Primary Range
Benign mammary dysplasia
This range includes codes for benign breast conditions, including 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 |
|---|---|---|---|
| N60.11 | Diffuse cystic mastopathy of right breast | Use when documentation specifies diffuse cystic changes in the right breast. |
|
| N60.12 | Diffuse cystic mastopathy of left breast | Use when documentation specifies diffuse cystic changes in the left breast. |
|
| N60.19 | Diffuse cystic mastopathy of unspecified breast | Use when laterality is not documented after provider query. |
|
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 cystic mastopathy
Essential facts and insights about Cystic Mastopathy
Primary ICD-10-CM Codes for cystic mastopathy
Decision Criteria
clinical Criteria
- Presence of multiple cysts in the right breast confirmed by imaging
documentation Criteria
- Documentation specifies 'diffuse cystic mastopathy of right breast'
Applicable To
- Diffuse cystic changes in the right breast
Clinical Validation Requirements
- Ultrasound showing multiple anechoic cysts in the right breast
- Mammogram indicating clustered microcysts
Code-Specific Risks
- Incorrectly coding as unspecified when laterality is documented
Coding Notes
- Ensure laterality is documented to avoid unspecified coding.
N60.12 - Diffuse cystic mastopathy of left breast
Use when documentation specifies diffuse cystic changes in the left breast.
Applicable To
- Diffuse cystic changes in the left breast
Excludes
- Fibroadenosis (N60.2)
- Unspecified lump in breast (N63)
Clinical Validation Requirements
- Ultrasound showing multiple anechoic cysts in the left breast
- Mammogram indicating clustered microcysts
Coding Notes
Ensure laterality is documented to avoid unspecified coding.
N60.19 - Diffuse cystic mastopathy of unspecified breast
Use when laterality is not documented after provider query.
Applicable To
- Diffuse cystic changes in an unspecified breast
Excludes
- Fibroadenosis (N60.2)
- Unspecified lump in breast (N63)
Clinical Validation Requirements
- Ultrasound showing multiple anechoic cysts without specified laterality
- Mammogram indicating clustered microcysts without specified laterality
Coding Notes
Query provider for laterality to avoid unspecified coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Cystic Mastopathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N60.11.
Impact
Clinical: Leads to incomplete clinical records., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Train staff to always document laterality, Use templates that prompt for laterality
Impact
Reimbursement: May lead to reduced reimbursement due to unspecified coding., Compliance: Non-compliance with coding guidelines requiring specificity., Data Quality: Decreases accuracy of clinical data and reporting.
Mitigation Strategy
Ensure documentation specifies laterality and use N60.11 or N60.12 accordingly.
Impact
Using unspecified codes when specific codes are applicable.
Mitigation Strategy
Implement regular audits to ensure laterality is documented and coded.
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 Cystic Mastopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Cystic Mastopathy
Use these documentation templates to ensure complete and accurate documentation for Cystic Mastopathy. These templates include all required elements for proper coding and billing.
Routine examination for breast cysts
Specialty: RadiologyRequired Elements
- Patient history of breast pain or lumps
- Physical examination findings
- Imaging results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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