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ICD-10 Guide
ICD-10 CodesN61.2

N61.2

Billable

Granulomatous mastitis

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

Code Description

ICD-10 N61.2 is a billable code used to indicate a diagnosis of granulomatous mastitis.

Key Diagnostic Point:

Granulomatous mastitis is a rare form of breast inflammation characterized by the formation of granulomas, which are small areas of inflammation due to the accumulation of immune cells. This condition primarily affects women of childbearing age and can present with symptoms such as breast lumps, pain, and sometimes nipple discharge. Granulomatous mastitis can be mistaken for other breast conditions, including infections or malignancies, making accurate diagnosis crucial. Imaging studies, such as mammography and ultrasound, are often employed to evaluate the breast tissue and rule out other causes of breast lumps. The etiology of granulomatous mastitis is not fully understood, but it may be associated with factors such as autoimmune diseases, infections, or even hormonal changes. Treatment typically involves corticosteroids or surgical intervention, depending on the severity of the condition and the patient's response to initial therapies. Given its benign nature, granulomatous mastitis is classified under benign breast diseases, but it requires careful management to prevent complications and ensure proper healing.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other types of mastitis and breast diseases
  • Potential overlap with malignant conditions
  • Variability in clinical presentation
  • Need for comprehensive imaging and documentation

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the type of mastitis
  • Misclassification as malignant conditions
  • Lack of imaging reports in the medical record

Specialty Focus

Medical Specialties

Breast Surgery

Documentation Requirements

Detailed clinical notes on symptoms, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with breast lumps and pain, requiring surgical evaluation.

Billing Considerations

Ensure clear documentation of differential diagnoses and treatment rationale.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing findings and recommendations.

Common Clinical Scenarios

Imaging studies performed for patients with suspected granulomatous mastitis.

Billing Considerations

Accurate correlation of imaging findings with clinical symptoms is essential.

Coding Guidelines

Inclusion Criteria

Use N61.2 When
  • According to ICD
  • 10 coding guidelines, N61
  • 2 should be used when granulomatous mastitis is specifically diagnosed
  • It is important to document the clinical findings, imaging results, and treatment plans to support the diagnosis

Exclusion Criteria

Do NOT use N61.2 When
  • Exclusion criteria include other types of mastitis or breast conditions that do not meet the criteria for granulomatous mastitis

Related ICD-10 Codes

Related CPT Codes

19120CPT Code

Excision, breast lesion

Clinical Scenario

When surgical intervention is required for granulomatous mastitis.

Documentation Requirements

Surgical notes detailing the procedure and findings.

Specialty Considerations

Breast surgeons should document the rationale for excision.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of granulomatous mastitis, improving the accuracy of data collection and reimbursement processes. This specificity helps in understanding the epidemiology and treatment outcomes of this rare condition.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of granulomatous mastitis, improving the accuracy of data collection and reimbursement processes. This specificity helps in understanding the epidemiology and treatment outcomes of this rare condition.

Reimbursement & Billing Impact

reimbursement processes. This specificity helps in understanding the epidemiology and treatment outcomes of this rare condition.

Resources

Clinical References

  • •
    Granulomatous Mastitis: A Review

Coding & Billing References

  • •
    Granulomatous Mastitis: A Review

Frequently Asked Questions

What are the common symptoms of granulomatous mastitis?

Common symptoms include breast lumps, pain, and sometimes nipple discharge. Patients may also experience localized swelling and tenderness.

How is granulomatous mastitis diagnosed?

Diagnosis typically involves clinical examination, imaging studies like ultrasound or mammography, and histopathological confirmation through biopsy.

What treatment options are available for granulomatous mastitis?

Treatment may include corticosteroids to reduce inflammation, antibiotics if an infection is suspected, and surgical intervention for severe cases.