ICD-10 Coding for Right Breast Pain(N64.4, N63.12)
Complete ICD-10-CM coding and documentation guide for Right Breast Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Breast Pain
N60-N64Primary Range
Disorders of breast
This range includes codes for various breast disorders, including pain and lumps.
Malignant neoplasm of breast
Relevant for cases where breast pain is associated with confirmed malignancy.
Abnormal and inconclusive findings on diagnostic imaging of breast
Used when imaging reveals abnormalities that could explain breast pain.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N64.4 | Mastodynia | Use for isolated right breast pain without identifiable mass or underlying condition. |
|
| N63.12 | Unspecified lump in the right breast | Use when a palpable lump is present in the right 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 right breast pain
Essential facts and insights about Right Breast Pain
Primary ICD-10-CM Codes for right breast pain
Decision Criteria
clinical Criteria
- Pain without palpable mass or abnormal imaging.
Applicable To
- Breast pain
- Mastalgia
Excludes
- Breast pain with confirmed malignancy (C50.911)
Clinical Validation Requirements
- Negative imaging for mass
- Cyclical pain pattern
Code-Specific Risks
- Risk of undercoding if underlying cause is not investigated.
Coding Notes
- Ensure documentation specifies laterality and cyclical nature if applicable.
N63.12 - Unspecified lump in the right breast
Use when a palpable lump is present in the right breast.
Applicable To
- Right breast mass
Excludes
- Confirmed malignant neoplasm (C50.911)
Clinical Validation Requirements
- Palpable mass on physical exam
- Imaging confirming solid mass
Coding Notes
Document the exact location and characteristics of the lump.
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 Right Breast Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N64.4.
Impact
Clinical: Inaccurate clinical assessment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Use templates with required fields, Regular training on documentation standards
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use N63.12 for the mass and N64.4 for associated pain.
Impact
Failure to document imaging results can lead to audit issues.
Mitigation Strategy
Ensure all imaging findings are included in the patient's record.
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 Right Breast Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Breast Pain
Use these documentation templates to ensure complete and accurate documentation for Right Breast Pain. These templates include all required elements for proper coding and billing.
Right breast pain with cyclical pattern
Specialty: Primary CareRequired Elements
- Pain description
- Cyclical nature
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Right Breast Pain? Ask your questions below.