ICD-10 Coding for Fibrocystic Disease of the Breast(N60.3, N60.19)
Complete ICD-10-CM coding and documentation guide for Fibrocystic Disease of the Breast. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fibrocystic Disease of the Breast
N60-N64Primary Range
Disorders of breast
This range includes all benign breast disorders, including fibrocystic changes.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N60.3 | Fibrosclerosis of breast | Use when biopsy confirms stromal fibrosis or sclerosis. |
|
| N60.19 | Other benign mammary dysplasia | Use when there are multiple cysts without fibrosis. |
|
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 fibrocystic disease of breast
Essential facts and insights about Fibrocystic Disease of the Breast
Primary ICD-10-CM Codes for fibrocystic disease of breast
Decision Criteria
clinical Criteria
- Biopsy confirms stromal fibrosis
Applicable To
- Fibrocystic changes with stromal fibrosis/sclerosis
Excludes
- Benign neoplasm of breast (D24)
Clinical Validation Requirements
- Biopsy shows stromal fibrosis/sclerosis
- Imaging reports 'dense fibrous tissue'
Code-Specific Risks
- Confusion with N60.19 or D24 codes
Coding Notes
- Ensure laterality is documented to avoid unspecified coding.
N60.19 - Other benign mammary dysplasia
Use when there are multiple cysts without fibrosis.
Applicable To
- Generalized fibrocystic changes without fibrosis
Excludes
- Fibrosclerosis of breast (N60.3)
Clinical Validation Requirements
- No fibrosis but multiple cysts with epithelial hyperplasia
Coding Notes
Ensure correct age group is considered when coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Upper outer quadrant breast pain
R10.13Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fibrocystic Disease of the Breast to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N60.3.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential denial of claims due to insufficient documentation.
Mitigation Strategy
Ensure all imaging findings are included in the patient record.
Impact
Reimbursement: May result in lower reimbursement rates., Compliance: Non-compliance with specificity requirements., Data Quality: Decreases accuracy of medical records.
Mitigation Strategy
Query provider for specific fibrocystic changes with or without fibrosis.
Impact
Using unspecified codes can trigger audits.
Mitigation Strategy
Ensure all documentation is specific and complete.
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 Fibrocystic Disease of the Breast, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fibrocystic Disease of the Breast
Use these documentation templates to ensure complete and accurate documentation for Fibrocystic Disease of the Breast. These templates include all required elements for proper coding and billing.
Fibrocystic changes with cyclical mastalgia
Specialty: General SurgeryRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Biopsy results
- Laterality
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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