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ICD-10 Guide
ICD-10 CodesN63.13

N63.13

Billable

Unspecified lump in the right breast, lower outer quadrant

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

Code Description

ICD-10 N63.13 is a billable code used to indicate a diagnosis of unspecified lump in the right breast, lower outer quadrant.

Key Diagnostic Point:

N63.13 refers to an unspecified lump located in the lower outer quadrant of the right breast. This code is often used when a patient presents with a palpable mass that has not been definitively diagnosed as benign or malignant. The differential diagnosis for breast lumps includes benign breast diseases such as fibrocystic changes, fibroadenomas, and lipomas, as well as inflammatory conditions like mastitis. Breast hypertrophy can also lead to the formation of lumps due to excess glandular tissue. Nipple discharge may accompany some breast lumps, necessitating further evaluation. Imaging studies, including mammography and ultrasound, are critical in assessing the characteristics of the lump, guiding management, and determining the need for biopsy. Accurate coding requires careful documentation of the lump's characteristics, associated symptoms, and imaging results to ensure appropriate treatment and follow-up.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of lump characteristics
  • Need for differential diagnosis consideration
  • Potential for benign vs malignant interpretation
  • Variability in imaging results and recommendations

Audit Risk Factors

  • Inadequate documentation of lump characteristics
  • Failure to document imaging results
  • Misinterpretation of benign vs malignant findings
  • Lack of follow-up documentation post-biopsy

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed documentation of lump characteristics, imaging results, and any biopsy findings.

Common Clinical Scenarios

Patients presenting with breast lumps requiring further evaluation for malignancy.

Billing Considerations

Ensure clear documentation of the clinical decision-making process and follow-up plans.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing findings and recommendations.

Common Clinical Scenarios

Imaging studies performed for breast lumps, including mammograms and ultrasounds.

Billing Considerations

Radiologists should provide clear descriptions of imaging findings to support coding.

Coding Guidelines

Inclusion Criteria

Use N63.13 When
  • According to ICD
  • 10 coding guidelines, N63
  • 13 should be used when a lump is identified but not specified as benign or malignant
  • Coders must ensure that the documentation supports the use of this code, including the location of the lump and any associated symptoms

Exclusion Criteria

Do NOT use N63.13 When
  • Exclusion criteria include any definitive diagnosis of malignancy or specific benign conditions

Related ICD-10 Codes

Related CPT Codes

77067CPT Code

Mammography, bilateral

Clinical Scenario

Used for screening or diagnostic evaluation of breast lumps.

Documentation Requirements

Document the reason for the mammogram and findings.

Specialty Considerations

Radiologists should ensure clear communication of findings to referring providers.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specificity in coding breast conditions, including the ability to specify the location of lumps. This has improved the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specificity in coding breast conditions, including the ability to specify the location of lumps. This has improved the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 should I document when coding N63.13?

Document the characteristics of the lump, any associated symptoms, imaging results, and follow-up plans to ensure accurate coding.