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ICD-10 Guide
ICD-10 CodesD48.62

D48.62

Billable

Neoplasm of uncertain behavior of left breast

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

Code Description

ICD-10 D48.62 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of left breast.

Key Diagnostic Point:

D48.62 refers to a neoplasm of uncertain behavior located in the left breast. This classification is used when the nature of the neoplasm is not definitively benign or malignant, making it challenging to determine the appropriate management and treatment strategies. Neoplasms of uncertain behavior can arise from various tissues within the breast, including epithelial and stromal components. These neoplasms may exhibit atypical features that warrant careful monitoring and evaluation. Surveillance is crucial, as some neoplasms may progress to malignancy over time, necessitating regular imaging and clinical assessments. The diagnosis often follows imaging studies, such as mammography or ultrasound, and may be confirmed through biopsy. The uncertainty surrounding these neoplasms requires a multidisciplinary approach, involving oncologists, radiologists, and pathologists, to ensure optimal patient outcomes. The management may include watchful waiting, surgical intervention, or further diagnostic procedures based on the neoplasm's behavior and patient risk factors.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Ambiguity in diagnosis requiring additional testing
  • Need for multidisciplinary collaboration for management
  • Potential for progression to malignancy
  • Variability in clinical presentation

Audit Risk Factors

  • Inadequate documentation of follow-up care
  • Failure to specify the type of neoplasm
  • Lack of clarity on the nature of the neoplasm
  • Insufficient justification for surveillance imaging

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Patients with abnormal mammograms requiring biopsy and follow-up.

Billing Considerations

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

Radiology

Documentation Requirements

Imaging reports with clear descriptions of findings and recommendations.

Common Clinical Scenarios

Imaging follow-up for neoplasms of uncertain behavior.

Billing Considerations

Document the rationale for imaging frequency and any changes in findings.

Coding Guidelines

Inclusion Criteria

Use D48.62 When
  • According to ICD
  • 10 guidelines, D48
  • 62 should be used when the neoplasm's behavior is uncertain, and it is essential to document the clinical rationale for this classification

Exclusion Criteria

Do NOT use D48.62 When
  • Exclusion criteria include definitive diagnoses of benign or malignant neoplasms

Related ICD-10 Codes

Related CPT Codes

19120CPT Code

Excision, breast lesion

Clinical Scenario

Used when a neoplasm of uncertain behavior is surgically excised.

Documentation Requirements

Operative reports detailing the procedure and findings.

Specialty Considerations

Oncologists should ensure clear documentation of the neoplasm's behavior pre- and post-surgery.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more precise coding of neoplasms, including those of uncertain behavior, facilitating better tracking of patient outcomes and treatment efficacy.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more precise coding of neoplasms, including those of uncertain behavior, facilitating better tracking of patient outcomes and treatment efficacy.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more precise coding of neoplasms, including those of uncertain behavior, facilitating better tracking of patient outcomes and treatment efficacy.

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 a growth that cannot be definitively classified as benign or malignant, requiring careful monitoring and evaluation.