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v1.0.0
ICD-10 Guide
ICD-10 CodesN64.1

N64.1

Billable

Fat necrosis of breast

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

Code Description

ICD-10 N64.1 is a billable code used to indicate a diagnosis of fat necrosis of breast.

Key Diagnostic Point:

Fat necrosis of the breast is a benign condition characterized by the formation of a lump in the breast tissue due to the breakdown of fat cells. This condition often arises following trauma, surgery, or radiation therapy to the breast. Clinically, fat necrosis may present as a firm, palpable mass that can mimic breast cancer, leading to diagnostic challenges. Patients may also experience associated symptoms such as tenderness or changes in skin texture over the affected area. Imaging studies, including mammography and ultrasound, are crucial for differentiating fat necrosis from malignant lesions. On imaging, fat necrosis typically appears as a well-defined, irregular mass with possible calcifications. While fat necrosis is not a life-threatening condition, it can cause significant anxiety for patients due to its potential to resemble malignancy. Management often involves reassurance, monitoring, and, in some cases, surgical intervention if the diagnosis is uncertain or if the mass is symptomatic.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from malignant breast conditions
  • Need for imaging studies to confirm diagnosis
  • Potential for misdiagnosis as breast cancer
  • Variability in presentation and symptoms

Audit Risk Factors

  • Inadequate documentation of imaging results
  • Failure to document prior trauma or surgery
  • Misclassification of fat necrosis as malignant
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Radiology

Documentation Requirements

Detailed imaging reports that specify findings consistent with fat necrosis.

Common Clinical Scenarios

Imaging of palpable breast masses, follow-up of previously diagnosed conditions.

Billing Considerations

Radiologists should clearly differentiate fat necrosis from malignancies in their reports.

Surgery

Documentation Requirements

Operative reports detailing the surgical history and findings during procedures.

Common Clinical Scenarios

Surgical excision of breast lumps suspected to be malignant.

Billing Considerations

Surgeons must document the rationale for excision and any findings that confirm fat necrosis.

Coding Guidelines

Inclusion Criteria

Use N64.1 When
  • According to ICD
  • 10 guidelines, N64
  • 1 should be used when fat necrosis is confirmed through imaging or clinical evaluation
  • It is important to document the patient's history of trauma or surgery, as this supports the diagnosis

Exclusion Criteria

Do NOT use N64.1 When
  • Exclusion criteria include any malignant conditions

Related ICD-10 Codes

Related CPT Codes

19301CPT Code

Mastectomy, partial (lumpectomy)

Clinical Scenario

Used when excising a lump suspected to be malignant but found to be fat necrosis.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Surgeons should document the rationale for excision and any findings that confirm fat necrosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like fat necrosis, improving the accuracy of diagnoses and treatment plans. This specificity aids in better patient management and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like fat necrosis, improving the accuracy of diagnoses and treatment plans. This specificity aids in better patient management and resource allocation.

Reimbursement & Billing Impact

reimbursement and minimizes audit risks.

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 is fat necrosis of the breast?

Fat necrosis of the breast is a benign condition characterized by the formation of a lump due to the breakdown of fat cells, often following trauma or surgery.

How is fat necrosis diagnosed?

Diagnosis is made through clinical evaluation and imaging studies, such as mammography and ultrasound, which help differentiate it from malignant lesions.

Is fat necrosis a serious condition?

No, fat necrosis is benign, but it can mimic breast cancer, causing anxiety for patients.

What are the treatment options for fat necrosis?

Treatment may involve observation, reassurance, and in some cases, surgical excision if the diagnosis is uncertain.