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ICD-10 Guide
ICD-10 CodesN61.20

N61.20

Billable

Granulomatous mastitis, unspecified breast

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

Code Description

ICD-10 N61.20 is a billable code used to indicate a diagnosis of granulomatous mastitis, unspecified breast.

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 can present as a palpable mass in the breast, often mimicking breast cancer, and may be associated with symptoms such as breast pain, swelling, and sometimes nipple discharge. The etiology of granulomatous mastitis is not fully understood, but it has been linked to various factors including autoimmune diseases, infections, and possibly hormonal influences. Diagnosis typically involves imaging studies such as mammography or ultrasound, followed by biopsy to confirm the presence of granulomas. Treatment may include corticosteroids or surgical intervention, depending on the severity and persistence of symptoms. Accurate coding is essential for proper management and reimbursement, as this condition can be confused with other benign and malignant breast diseases.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other types of mastitis and breast diseases.
  • Need for comprehensive documentation to support diagnosis.
  • Potential for misdiagnosis as breast cancer.
  • Variability in clinical presentation and symptoms.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to provide imaging or biopsy results.
  • Misclassification of the condition as malignant.
  • Inconsistent coding practices among providers.

Specialty Focus

Medical Specialties

Breast Surgery

Documentation Requirements

Detailed clinical notes including physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with breast lumps, pain, or discharge requiring surgical evaluation.

Billing Considerations

Ensure clear documentation of differential diagnoses and rationale for surgical intervention.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing findings and recommendations for further evaluation.

Common Clinical Scenarios

Imaging studies performed for patients with suspected breast masses.

Billing Considerations

Accurate reporting of imaging findings is crucial for coding and diagnosis confirmation.

Coding Guidelines

Inclusion Criteria

Use N61.20 When
  • Follow official ICD
  • CM guidelines for coding and reporting
  • Ensure that the diagnosis is supported by clinical documentation, imaging studies, and biopsy results
  • 20 should be used when the specific type of granulomatous mastitis is not specified

Exclusion Criteria

Do NOT use N61.20 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

19100CPT Code

Biopsy of breast, needle core

Clinical Scenario

Used when a biopsy is performed to confirm granulomatous mastitis.

Documentation Requirements

Document the indication for biopsy and results.

Specialty Considerations

Ensure alignment with surgical notes and pathology reports.

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 diagnosis and treatment tracking. This specificity aids in better understanding the epidemiology and management of the condition.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of granulomatous mastitis, improving the accuracy of diagnosis and treatment tracking. This specificity aids in better understanding the epidemiology and management of the condition.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of granulomatous mastitis, improving the accuracy of diagnosis and treatment tracking. This specificity aids in better understanding the epidemiology and management of the condition.

Resources

Clinical References

  • •
    American College of Radiology - Breast Imaging

Coding & Billing References

  • •
    American College of Radiology - Breast Imaging

Frequently Asked Questions

What are the common symptoms of granulomatous mastitis?

Common symptoms include breast pain, swelling, the presence of a lump, and sometimes nipple discharge. It may also present with localized redness and warmth.

How is granulomatous mastitis diagnosed?

Diagnosis typically involves a combination of clinical examination, imaging studies such as ultrasound or mammography, and histological confirmation through biopsy.

What is the treatment for granulomatous mastitis?

Treatment may include corticosteroids to reduce inflammation, antibiotics if an infection is suspected, and in some cases, surgical intervention to remove affected tissue.