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v1.0.0
ICD-10 Guide
ICD-10 CodesN63.23

N63.23

Billable

Unspecified lump in the left breast, lower outer quadrant

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

Code Description

ICD-10 N63.23 is a billable code used to indicate a diagnosis of unspecified lump in the left breast, lower outer quadrant.

Key Diagnostic Point:

N63.23 refers to an unspecified lump located in the lower outer quadrant of the left breast. This code is used when a patient presents with a palpable mass in this specific area, but further characterization of the lump is not provided. The differential diagnosis for breast lumps includes benign conditions such as fibroadenomas, cysts, and lipomas, as well as malignant tumors. In many cases, imaging studies such as mammography or ultrasound are utilized to evaluate the lump further. Benign breast diseases, including mastitis and breast hypertrophy, may also present with lumps, but they typically have additional clinical features. Nipple discharge can accompany some breast conditions, necessitating thorough evaluation. Accurate coding requires careful documentation of the lump's characteristics, associated symptoms, and any imaging or biopsy results to ensure appropriate management and follow-up.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Lack of specificity regarding the nature of the lump (benign vs malignant)
  • Need for additional imaging or biopsy to determine the diagnosis
  • Potential overlap with other breast conditions requiring careful differentiation
  • Variability in clinical presentation and documentation standards across specialties

Audit Risk Factors

  • Inadequate documentation of the lump's characteristics
  • Failure to include imaging results in the medical record
  • Misuse of unspecified codes when more specific codes are available
  • Inconsistent terminology used in documentation

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed imaging reports, biopsy results, and treatment plans.

Common Clinical Scenarios

Patients presenting with breast lumps requiring further evaluation for malignancy.

Billing Considerations

Ensure that all findings are documented clearly to support the diagnosis and treatment plan.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing the characteristics of the lump.

Common Clinical Scenarios

Performing mammograms or ultrasounds to evaluate breast lumps.

Billing Considerations

Radiologists must provide clear descriptions of findings to aid in accurate coding.

Coding Guidelines

Inclusion Criteria

Use N63.23 When
  • According to ICD
  • 10 coding guidelines, N63
  • 23 should be used when the lump is not further specified
  • Coders should ensure that the documentation supports the use of this code and that any additional findings are captured with appropriate codes

Exclusion Criteria

Do NOT use N63.23 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

77067CPT Code

Breast ultrasound

Clinical Scenario

Used to evaluate the characteristics of the lump.

Documentation Requirements

Imaging report must detail findings and recommendations.

Specialty Considerations

Radiologists should ensure clarity in their reports to support coding.

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, improving the accuracy of diagnoses and treatment plans. N63.23 provides a clear designation for unspecified lumps, facilitating better tracking and management of breast health.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast conditions, improving the accuracy of diagnoses and treatment plans. N63.23 provides a clear designation for unspecified lumps, facilitating better tracking and management of breast health.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of breast conditions, improving the accuracy of diagnoses and treatment plans. N63.23 provides a clear designation for unspecified lumps, facilitating better tracking and management of breast health.

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 N63.23?

Document the characteristics of the lump, any associated symptoms, imaging results, and follow-up plans. Ensure that all relevant clinical information is included to support the diagnosis.