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v1.0.0
ICD-10 Guide
ICD-10 CodesD48.61

D48.61

Billable

Neoplasm of uncertain behavior of right breast

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 D48.61 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of right breast.

Key Diagnostic Point:

D48.61 refers to a neoplasm of uncertain behavior located in the right breast. Neoplasms of uncertain behavior are tumors that cannot be definitively classified as benign or malignant based on histological examination. This classification is crucial as it influences management decisions and patient prognosis. The uncertainty surrounding these neoplasms necessitates careful monitoring and follow-up, as there is a potential for progression to malignancy. Patients may present with a palpable mass, abnormal imaging findings, or incidental findings during routine screenings. Surveillance strategies often include regular imaging studies, clinical examinations, and possibly biopsy to assess any changes in the neoplasm's characteristics. The management of these neoplasms is multidisciplinary, involving oncologists, radiologists, and pathologists to ensure comprehensive care. The ambiguity in behavior can lead to anxiety for patients and requires clear communication regarding the potential risks and the importance of follow-up care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Uncertainty in behavior classification
  • Need for ongoing surveillance and follow-up
  • Potential for progression to malignancy
  • Variability in clinical presentation

Audit Risk Factors

  • Inadequate documentation of follow-up care
  • Failure to document imaging results
  • Lack of clarity on the neoplasm's behavior
  • Inconsistent coding of related conditions

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Patients presenting with a breast mass requiring biopsy and follow-up imaging.

Billing Considerations

Ensure clear documentation of the neoplasm's behavior and any changes over time.

Radiology

Documentation Requirements

Imaging reports detailing findings and recommendations for follow-up.

Common Clinical Scenarios

Imaging studies revealing suspicious breast lesions.

Billing Considerations

Accurate reporting of imaging findings is crucial for appropriate coding.

Coding Guidelines

Inclusion Criteria

Use D48.61 When
  • According to ICD
  • 10 guidelines, D48
  • 61 should be used when a neoplasm's behavior is uncertain and cannot be classified as benign or malignant
  • It is essential to document the clinical findings and any diagnostic procedures performed

Exclusion Criteria

Do NOT use D48.61 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

19120CPT Code

Excision, breast lesion

Clinical Scenario

Used when a biopsy is performed on a neoplasm of uncertain behavior.

Documentation Requirements

Pathology report and imaging studies must be documented.

Specialty Considerations

Oncologists should ensure that the behavior of the neoplasm is clearly documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior, which aids in better tracking and management of these conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior, which aids in better tracking and management of these conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior, which aids in better tracking and management of these conditions.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What does 'neoplasm of uncertain behavior' mean?

It refers to tumors that cannot be definitively classified as benign or malignant based on histological examination, necessitating careful monitoring.