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v1.0.0
ICD-10 Guide
ICD-10 CodesN63.41

N63.41

Billable

Unspecified lump in right breast, subareolar

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

Code Description

ICD-10 N63.41 is a billable code used to indicate a diagnosis of unspecified lump in right breast, subareolar.

Key Diagnostic Point:

The ICD-10 code N63.41 refers to an unspecified lump located in the right breast, specifically in the subareolar region, which is the area beneath the nipple. This condition can arise from various benign breast diseases, including fibrocystic changes, fibroadenomas, or other non-cancerous growths. It is essential to differentiate these lumps from malignant conditions through appropriate imaging and clinical evaluation. The subareolar region is particularly significant as it may also be associated with conditions such as mastitis, which is an infection of the breast tissue, or breast hypertrophy, where there is an abnormal increase in breast size. Patients may present with symptoms such as nipple discharge, tenderness, or changes in breast contour. Imaging studies, including mammography and ultrasound, are critical in evaluating these lumps to determine their nature and guide further management. Accurate coding requires careful documentation of the clinical findings, imaging results, and any associated symptoms to ensure appropriate treatment and follow-up.

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
  • Documentation requirements for imaging and clinical findings
  • Potential for overlapping symptoms with other breast conditions

Audit Risk Factors

  • Insufficient documentation of clinical findings
  • Lack of imaging reports to support diagnosis
  • Failure to specify the nature of the lump
  • Inadequate follow-up documentation

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed imaging reports, pathology results, and clinical notes regarding the lump's characteristics.

Common Clinical Scenarios

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

Billing Considerations

Need for thorough documentation to differentiate between benign and malignant conditions.

Radiology

Documentation Requirements

Comprehensive imaging studies, including mammograms and ultrasounds, with clear interpretations.

Common Clinical Scenarios

Routine screening and diagnostic imaging for patients presenting with breast lumps.

Billing Considerations

Accurate coding based on imaging findings and correlation with clinical symptoms.

Coding Guidelines

Inclusion Criteria

Use N63.41 When
  • According to official coding guidelines, N63
  • 41 should be used when a lump is identified in the right breast's subareolar region without a specified diagnosis
  • Coders must ensure that the documentation supports the diagnosis and that any imaging studies are included

Exclusion Criteria

Do NOT use N63.41 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

77067CPT Code

Breast ultrasound

Clinical Scenario

Used for imaging evaluation of a breast lump.

Documentation Requirements

Include clinical indications and findings from the ultrasound.

Specialty Considerations

Radiology must correlate findings with clinical symptoms.

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. N63.41 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. N63.41 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. N63.41 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 be documented to support the use of N63.41?

Documentation should include the patient's clinical history, physical examination findings, imaging results, and any relevant laboratory tests to support the diagnosis of an unspecified lump in the right breast.