ICD-10 Coding for Breast Cystic Conditions(N60.11, N60.12, N60.01, N60.02)
Complete ICD-10-CM coding and documentation guide for Breast Cystic Conditions. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Cystic Conditions
N60.0-N60.1Primary Range
Benign mammary dysplasia
This range covers conditions related to cystic changes in the breast, including solitary and multiple cysts.
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 imaging confirms multiple cysts in the right breast. |
|
| N60.12 | Diffuse cystic mastopathy of left breast | Use when imaging confirms multiple cysts in the left breast. |
|
| N60.01 | Solitary cyst of right breast | Use when imaging confirms a single cyst in the right breast. |
|
| N60.02 | Solitary cyst of left breast | Use when imaging confirms a single cyst in the left 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: ICD-10 code for cystic breast conditions
Essential facts and insights about Breast Cystic Conditions
Primary ICD-10-CM Codes for cystitis breast
Decision Criteria
clinical Criteria
- Presence of multiple cysts in imaging
Applicable To
- Multiple cysts in right breast
Excludes
- Solitary cyst of right breast (N60.01)
Clinical Validation Requirements
- Ultrasound confirming multiple cysts in right breast
Code-Specific Risks
- Incorrectly coding as solitary cyst
Coding Notes
- Ensure laterality is documented to avoid unspecified codes.
N60.12 - Diffuse cystic mastopathy of left breast
Use when imaging confirms multiple cysts in the left breast.
Applicable To
- Multiple cysts in left breast
Excludes
- Solitary cyst of left breast (N60.02)
Clinical Validation Requirements
- Ultrasound confirming multiple cysts in left breast
Coding Notes
Ensure laterality is documented to avoid unspecified codes.
N60.01 - Solitary cyst of right breast
Use when imaging confirms a single cyst in the right breast.
Applicable To
- Single cyst in right breast
Excludes
- Diffuse cystic mastopathy of right breast (N60.11)
Clinical Validation Requirements
- Ultrasound confirming a single cyst in right breast
Coding Notes
Ensure laterality is documented to avoid unspecified codes.
N60.02 - Solitary cyst of left breast
Use when imaging confirms a single cyst in the left breast.
Applicable To
- Single cyst in left breast
Excludes
- Diffuse cystic mastopathy of left breast (N60.12)
Clinical Validation Requirements
- Ultrasound confirming a single cyst in left breast
Coding Notes
Ensure laterality is documented to avoid unspecified codes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Mastodynia
N64.4Differential 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 Cystic Conditions to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N60.11.
Impact
Clinical: Inaccurate diagnosis and treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Ensure imaging reports specify the number of cysts.
Impact
Reimbursement: May lead to incorrect DRG assignment and reimbursement issues., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Verify the number of cysts via imaging and use N60.1 if multiple cysts are present.
Impact
Reimbursement: Unspecified codes may lead to reduced reimbursement., Compliance: Potential non-compliance with payer requirements., Data Quality: Decreased specificity in patient records.
Mitigation Strategy
Ensure documentation specifies right or left breast to avoid unspecified codes.
Impact
Use of unspecified codes can trigger audits due to lack of specificity.
Mitigation Strategy
Ensure documentation includes laterality and cyst count.
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 Cystic Conditions, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Breast Cystic Conditions
Use these documentation templates to ensure complete and accurate documentation for Breast Cystic Conditions. These templates include all required elements for proper coding and billing.
Multiple cysts in bilateral breasts
Specialty: RadiologyRequired Elements
- Patient history
- Imaging findings
- Cyst count and location
- Laterality
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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