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v1.0.0
ICD-10 Guide
ICD-10 CodesN63.42

N63.42

Billable

Unspecified lump in left breast, subareolar

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

Code Description

ICD-10 N63.42 is a billable code used to indicate a diagnosis of unspecified lump in left breast, subareolar.

Key Diagnostic Point:

N63.42 refers to an unspecified lump located in the left breast, specifically beneath the areola. This condition may arise from various benign breast diseases, including fibrocystic changes, fibroadenomas, or other non-cancerous growths. The subareolar region is particularly significant as it can be associated with conditions such as ductal ectasia or periductal mastitis, which may present with symptoms like nipple discharge or tenderness. While the lump itself is classified as unspecified, it is crucial for healthcare providers to conduct thorough evaluations, including imaging studies such as mammograms or ultrasounds, to rule out malignancy and to assess the characteristics of the lump. The management of such lumps often involves monitoring, aspiration, or surgical intervention depending on the clinical findings and patient symptoms. Accurate coding is essential for appropriate treatment and reimbursement, as well as for tracking the prevalence of breast conditions in the population.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and underlying causes of breast lumps.
  • Need for precise documentation to differentiate between benign and malignant conditions.
  • Potential for overlapping symptoms with other breast conditions.
  • Requirement for imaging studies to confirm diagnosis and guide treatment.

Audit Risk Factors

  • Inadequate documentation of the clinical findings and imaging results.
  • Failure to specify the nature of the lump (benign vs. malignant).
  • Lack of follow-up documentation regarding the management of the lump.
  • Inconsistent coding practices among different providers.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports and imaging studies are essential.

Common Clinical Scenarios

Evaluation of breast lumps for potential malignancy.

Billing Considerations

Need for multidisciplinary approach in treatment planning.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing findings and recommendations.

Common Clinical Scenarios

Performing mammograms and ultrasounds for breast lumps.

Billing Considerations

Clear communication of imaging results to referring physicians.

Coding Guidelines

Inclusion Criteria

Use N63.42 When
  • According to official coding guidelines, N63
  • 42 should be used when a lump is identified in the left breast subareolar region without further specification
  • Coders must ensure that the documentation supports the diagnosis and that any imaging studies are referenced

Exclusion Criteria

Do NOT use N63.42 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

19281CPT Code

Breast biopsy, percutaneous, needle

Clinical Scenario

Used when a biopsy is performed on a lump identified in the left breast.

Documentation Requirements

Documentation must include indication for biopsy and imaging results.

Specialty Considerations

Oncology specialists may require additional pathology reports.

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 diagnosis and treatment tracking. N63.42 provides a clear designation for unspecified lumps in the left breast, aiding in better patient management and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast conditions, improving the accuracy of diagnosis and treatment tracking. N63.42 provides a clear designation for unspecified lumps in the left breast, aiding in better patient management and research.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of breast conditions, improving the accuracy of diagnosis and treatment tracking. N63.42 provides a clear designation for unspecified lumps in the left breast, aiding in better patient management and research.

Resources

Clinical References

  • •
    American College of Radiology - Breast Imaging

Coding & Billing References

  • •
    American College of Radiology - Breast Imaging

Frequently Asked Questions

What should be documented to support the use of N63.42?

Documentation should include a detailed description of the lump, imaging results, any associated symptoms, and the clinical rationale for the diagnosis.