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v1.0.0
ICD-10 Guide
ICD-10 CodesN63.15

N63.15

Billable

Unspecified lump in the right breast, overlapping quadrants

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

Code Description

ICD-10 N63.15 is a billable code used to indicate a diagnosis of unspecified lump in the right breast, overlapping quadrants.

Key Diagnostic Point:

N63.15 refers to an unspecified lump located in the right breast that overlaps multiple quadrants. This code is often used when a palpable mass is detected during a clinical examination or imaging study, but the exact nature of the lump remains undetermined. The lump may be benign, such as a fibroadenoma or cyst, or it could be indicative of a more serious condition, necessitating further evaluation. Common benign breast diseases include mastitis, which is an infection that can cause swelling and tenderness, and breast hypertrophy, characterized by excessive breast tissue. Patients may also present with symptoms such as nipple discharge, which can complicate the clinical picture. Imaging studies, including mammography and ultrasound, are critical in the assessment of breast lumps, helping to differentiate between benign and malignant lesions. Accurate coding is essential for appropriate management and treatment planning, as well as for insurance reimbursement purposes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and symptoms
  • Need for differential diagnosis to rule out malignancy
  • Potential for overlapping conditions (e.g., mastitis, cysts)
  • Documentation requirements for imaging and follow-up

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document imaging results
  • Lack of follow-up notes on the lump's progression
  • Misclassification of benign versus malignant conditions

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports and imaging studies must be included.

Common Clinical Scenarios

Patients presenting with suspicious breast lumps requiring biopsy.

Billing Considerations

Ensure clear documentation of the lump's characteristics and any follow-up imaging.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing findings and recommendations.

Common Clinical Scenarios

Breast imaging for patients with palpable lumps or abnormal mammograms.

Billing Considerations

Accurate coding based on imaging findings is crucial for reimbursement.

Coding Guidelines

Inclusion Criteria

Use N63.15 When
  • According to ICD
  • 10 guidelines, N63
  • 15 should be used when a lump is identified but not specified as benign or malignant
  • It is important to document the location and characteristics of the lump, as well as any relevant imaging studies

Exclusion Criteria

Do NOT use N63.15 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

77067CPT Code

Breast ultrasound

Clinical Scenario

Used to evaluate the lump in the right breast.

Documentation Requirements

Include imaging findings and recommendations for follow-up.

Specialty Considerations

Radiologists should ensure accurate coding based on findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of breast conditions, including the ability to capture the complexity of overlapping quadrants, which was less detailed in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast conditions, including the ability to capture the complexity of overlapping quadrants, which was less detailed in ICD-9.

Reimbursement & Billing Impact

reimbursement.

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 using N63.15?

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