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ICD-10 Guide
ICD-10 CodesN60.19

N60.19

Billable

Diffuse cystic mastopathy of unspecified breast

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/18/2025

Code Description

ICD-10 N60.19 is a billable code used to indicate a diagnosis of diffuse cystic mastopathy of unspecified breast.

Key Diagnostic Point:

Diffuse cystic mastopathy, also known as fibrocystic breast disease, is a benign condition characterized by the presence of multiple cysts in the breast tissue. This condition is often associated with hormonal fluctuations, particularly estrogen, which can lead to the development of cysts and fibrous tissue. Patients may present with breast tenderness, lumpiness, and sometimes nipple discharge. The condition is typically diagnosed through clinical examination and imaging studies such as mammography or ultrasound. While diffuse cystic mastopathy is not cancerous, it can cause significant discomfort and anxiety for patients. Management often includes reassurance, lifestyle modifications, and in some cases, hormonal therapy. It is important for healthcare providers to differentiate this condition from malignant breast diseases, as the symptoms can overlap. Regular follow-up and monitoring are recommended to ensure that any changes in breast tissue are appropriately evaluated.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between benign and malignant breast conditions
  • Variability in patient presentation and symptoms
  • Need for comprehensive documentation of imaging results
  • Potential overlap with other breast conditions such as mastitis or hypertrophy

Audit Risk Factors

  • Inadequate documentation of symptoms and clinical findings
  • Failure to specify the breast involved when applicable
  • Misinterpretation of imaging results leading to incorrect coding
  • Lack of follow-up documentation for ongoing management

Specialty Focus

Medical Specialties

Radiology

Documentation Requirements

Detailed imaging reports including findings, impressions, and recommendations.

Common Clinical Scenarios

Patients presenting for routine screening or evaluation of breast lumps.

Billing Considerations

Ensure imaging findings correlate with clinical symptoms to avoid misdiagnosis.

Oncology

Documentation Requirements

Comprehensive patient history, physical examination findings, and imaging results.

Common Clinical Scenarios

Patients with a history of breast lumps requiring further evaluation.

Billing Considerations

Differentiating benign conditions from malignancies is crucial for treatment planning.

Coding Guidelines

Inclusion Criteria

Use N60.19 When
  • According to ICD
  • 10 coding guidelines, N60
  • 19 should be used when the condition is confirmed as diffuse cystic mastopathy without specifying the breast
  • It is important to document the clinical findings and any imaging studies performed to support the diagnosis

Exclusion Criteria

Do NOT use N60.19 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

77067CPT Code

Breast ultrasound

Clinical Scenario

Used for evaluation of breast lumps or cysts.

Documentation Requirements

Complete imaging report with findings and recommendations.

Specialty Considerations

Radiology must correlate findings with clinical symptoms.

19281CPT Code

Breast biopsy, percutaneous

Clinical Scenario

When cysts are aspirated or biopsied for further evaluation.

Documentation Requirements

Detailed report of the procedure and pathology results.

Specialty Considerations

Oncology must ensure clear documentation of benign versus malignant findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of breast conditions, including diffuse cystic mastopathy. This specificity aids in better tracking of benign breast diseases and improves the accuracy of patient records and treatment plans.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast conditions, including diffuse cystic mastopathy. This specificity aids in better tracking of benign breast diseases and improves the accuracy of patient records and treatment plans.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of breast conditions, including diffuse cystic mastopathy. This specificity aids in better tracking of benign breast diseases and improves the accuracy of patient records and treatment plans.

Resources

Clinical References

  • •
    American College of Radiology - Breast Imaging

Coding & Billing References

  • •
    American College of Radiology - Breast Imaging

Frequently Asked Questions

What is diffuse cystic mastopathy?

Diffuse cystic mastopathy is a benign breast condition characterized by the presence of multiple cysts in the breast tissue, often associated with hormonal changes. It can cause symptoms such as breast tenderness and lumpiness.

How is diffuse cystic mastopathy diagnosed?

Diagnosis is typically made through clinical examination and imaging studies such as mammography or ultrasound, which reveal cystic changes in the breast tissue.

Is diffuse cystic mastopathy a risk factor for breast cancer?

While diffuse cystic mastopathy is a benign condition, it does not increase the risk of breast cancer. However, regular monitoring is recommended to differentiate it from malignant conditions.

What are the treatment options for diffuse cystic mastopathy?

Management often includes reassurance, lifestyle modifications, and in some cases, hormonal therapy to alleviate symptoms. Regular follow-up is important to monitor any changes.