ICD-10 Coding for Macromastia(N62)
Complete ICD-10-CM coding and documentation guide for Macromastia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Macromastia
N60-N64Primary Range
Disorders of breast
This range includes codes for various breast disorders, with N62 specifically addressing hypertrophy of the breast.
Dorsopathies
Includes codes for back pain and related conditions that may be associated with macromastia.
Dermatitis and eczema
Includes codes for skin conditions like intertrigo, which can occur in the inframammary fold due to macromastia.
Key Information: ICD-10 code for macromastia
Essential facts and insights about Macromastia
Primary ICD-10-CM Code for macromastia
Decision Criteria
clinical Criteria
- Document breast size and weight impact on symptoms.
documentation Criteria
- Include failed conservative management attempts.
Applicable To
- Breast hypertrophy
- Gigantomastia
Excludes
- Congenital breast deformities (Q83.8)
Clinical Validation Requirements
- BSA ≥1.35m²
- Schnur scale >22nd percentile
Code-Specific Risks
- Inadequate documentation of breast size impact
- Failure to document conservative treatment attempts
Coding Notes
- Ensure documentation includes specific symptoms and failed conservative treatments.
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.
Other congenital malformations of breast
Q83.8Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Macromastia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N62.
Impact
Clinical: Inadequate symptom management, Regulatory: Non-compliance with documentation standards, Financial: Potential claim denials
Mitigation Strategy
Use specific symptom descriptions, Link symptoms to breast size
Impact
Reimbursement: May lead to denied claims if specificity is lacking., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Reduces the accuracy of clinical data.
Mitigation Strategy
Use specific musculoskeletal codes like M54.6 for back pain.
Impact
Failure to document specific symptoms and treatments.
Mitigation Strategy
Implement structured templates for documentation.
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 Macromastia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Macromastia
Use these documentation templates to ensure complete and accurate documentation for Macromastia. These templates include all required elements for proper coding and billing.
Patient with symptomatic macromastia
Specialty: Plastic SurgeryRequired Elements
- Breast size and weight impact
- Failed conservative treatments
- Photographic evidence
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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