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ICD-10 Guide
ICD-10 CodesN61.22

N61.22

Billable

Granulomatous mastitis, left breast

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

Code Description

ICD-10 N61.22 is a billable code used to indicate a diagnosis of granulomatous mastitis, left 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 immune system's response to an irritant or infection. This condition primarily affects women of childbearing age and can present with symptoms such as breast pain, swelling, and the presence of lumps. In the case of N61.22, the condition specifically affects the left breast. Granulomatous mastitis can be associated with various factors, including autoimmune diseases, infections, and even certain medications. Diagnosis typically involves imaging studies such as mammography or ultrasound, followed by a biopsy to confirm the presence of granulomas. Treatment may include corticosteroids or surgical intervention, depending on the severity of the condition. Accurate coding is essential for proper management and reimbursement, as this condition can mimic other breast diseases, necessitating thorough documentation and differentiation from other types of mastitis and breast lumps.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other types of mastitis
  • Need for precise documentation of symptoms and imaging findings
  • Potential overlap with other breast conditions such as breast cancer
  • Variability in treatment approaches and their documentation

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to include imaging results in the medical record
  • Misclassification of the type of mastitis
  • Lack of follow-up documentation on treatment response

Specialty Focus

Medical Specialties

Breast Surgery

Documentation Requirements

Detailed surgical notes, imaging results, and pathology reports.

Common Clinical Scenarios

Surgical intervention for granulomatous mastitis, management of recurrent cases.

Billing Considerations

Ensure clear documentation of the surgical approach and any complications.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing findings and recommendations.

Common Clinical Scenarios

Imaging evaluation of breast lumps and inflammatory changes.

Billing Considerations

Accurate correlation of imaging findings with clinical symptoms is crucial.

Coding Guidelines

Inclusion Criteria

Use N61.22 When
  • Follow the official ICD
  • CM coding guidelines for specificity in coding breast conditions
  • Ensure that the diagnosis is supported by clinical documentation, imaging studies, and pathology results

Exclusion Criteria

Do NOT use N61.22 When
  • Exclude conditions that do not meet the criteria for granulomatous mastitis

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

Breast surgeons should ensure clear documentation of the procedure and findings.

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 better tracking of the condition and its management.

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 better tracking of the condition and its management.

Reimbursement & Billing Impact

reimbursement processes. This specificity helps in better tracking of the condition and its management.

Resources

Clinical References

  • •
    American College of Radiology

Coding & Billing References

  • •
    American College of Radiology

Frequently Asked Questions

What are the common symptoms of granulomatous mastitis?

Common symptoms include breast pain, swelling, the presence of lumps, and sometimes nipple discharge. Patients may also experience tenderness in the affected area.