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ICDxICD-10 Medical Coding

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ICD-10 Guide
ICD-10 CodesN63.4

N63.4

Billable

Unspecified lump in breast, subareolar

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

Code Description

ICD-10 N63.4 is a billable code used to indicate a diagnosis of unspecified lump in breast, subareolar.

Key Diagnostic Point:

The ICD-10 code N63.4 refers to an unspecified lump located in the breast, specifically beneath the areola. This condition can arise from various benign breast diseases, including fibrocystic changes, fibroadenomas, or other non-cancerous growths. It may also be associated with mastitis, which is an infection of the breast tissue that can lead to inflammation and the formation of lumps. Breast hypertrophy, characterized by excessive breast tissue growth, can also present as a lump in this area. Patients may report symptoms such as nipple discharge, which can complicate the clinical picture and necessitate further investigation. Imaging studies, such as mammography or ultrasound, are often employed to evaluate the characteristics of the lump and rule out malignancy. Accurate diagnosis is crucial, as the management of benign conditions differs significantly from that of malignant ones. The presence of a lump in the subareolar region warrants careful assessment, particularly in women over 40, due to the potential risk of breast cancer. Therefore, thorough clinical evaluation and appropriate imaging are essential components of the diagnostic process.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation of breast lumps
  • Need for differential diagnosis to rule out malignancy
  • Potential for overlapping symptoms with other breast conditions
  • 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 or treatment plans
  • Misclassification of benign versus malignant conditions

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed documentation of imaging results, biopsy reports, and treatment plans.

Common Clinical Scenarios

Evaluation of breast lumps in patients with a family history of breast cancer.

Billing Considerations

Need for thorough documentation to support the diagnosis and treatment plan, especially in cases of suspected malignancy.

Radiology

Documentation Requirements

Clear imaging reports detailing findings and recommendations for further evaluation.

Common Clinical Scenarios

Performing mammograms or ultrasounds for patients presenting with breast lumps.

Billing Considerations

Radiologists must ensure that imaging findings correlate with clinical symptoms and that follow-up recommendations are documented.

Coding Guidelines

Inclusion Criteria

Use N63.4 When
  • According to official coding guidelines, N63
  • 4 should be used when the lump is not specified as benign or malignant
  • Coders should ensure that the documentation supports the diagnosis and that any imaging studies performed are noted

Exclusion Criteria

Do NOT use N63.4 When
  • Exclusion criteria include specific diagnoses that provide a more precise code

Related ICD-10 Codes

Related CPT Codes

77067CPT Code

Mammography, bilateral

Clinical Scenario

Used for screening or diagnostic evaluation of breast lumps.

Documentation Requirements

Documentation of clinical findings and reason for imaging.

Specialty Considerations

Radiologists must ensure that the imaging correlates with the clinical diagnosis.

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 identify the location of lumps. This specificity aids in better tracking of breast health and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specificity in coding breast conditions, including the ability to identify the location of lumps. This specificity aids in better tracking of breast health and outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specificity in coding breast conditions, including the ability to identify the location of lumps. This specificity aids in better tracking of breast health and outcomes.

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 N63.4?

Document the clinical findings, imaging results, and any treatment plans. Ensure that the rationale for the diagnosis is clear and that any follow-up is noted.