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v1.0.0
ICD-10 Guide
ICD-10 CodesN64.4

N64.4

Billable

Mastodynia

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

Code Description

ICD-10 N64.4 is a billable code used to indicate a diagnosis of mastodynia.

Key Diagnostic Point:

Mastodynia, commonly referred to as breast pain, is a condition characterized by discomfort or pain in the breast tissue. It can occur cyclically, often correlating with the menstrual cycle, or it may be non-cyclical, presenting independently of hormonal fluctuations. The etiology of mastodynia can be multifactorial, including benign breast diseases such as fibrocystic changes, mastitis, or breast hypertrophy. In some cases, breast lumps or cysts may contribute to the sensation of pain. Nipple discharge, whether bloody or clear, can also be associated with mastodynia, necessitating further evaluation to rule out malignancy or other underlying conditions. Imaging studies, such as mammography or ultrasound, are often employed to assess breast tissue and identify any abnormalities. Accurate diagnosis and management of mastodynia require a thorough clinical history, physical examination, and appropriate imaging, as the condition can significantly impact a patient's quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying causes (benign and malignant)
  • Need for differential diagnosis with other breast conditions
  • Variability in patient presentation and symptomatology
  • Documentation requirements for imaging and clinical findings

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document imaging results
  • Misclassification of pain type (cyclical vs. non-cyclical)
  • Lack of follow-up documentation for ongoing symptoms

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Detailed patient history, physical examination findings, and any imaging results.

Common Clinical Scenarios

Patients presenting with breast pain, cyclical symptoms, or associated nipple discharge.

Billing Considerations

Ensure documentation reflects the nature of the pain and any associated symptoms to support the diagnosis.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing findings and recommendations.

Common Clinical Scenarios

Imaging studies performed for patients with breast pain or abnormal findings on physical examination.

Billing Considerations

Radiologists should ensure that the clinical indications for imaging are clearly documented to support the necessity of the procedure.

Coding Guidelines

Inclusion Criteria

Use N64.4 When
  • According to ICD
  • 10 guidelines, N64
  • 4 should be used when the primary complaint is breast pain without a specified underlying cause
  • It is essential to document any associated symptoms or findings that may indicate a more serious condition

Exclusion Criteria

Do NOT use N64.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

77067CPT Code

Mammography, bilateral

Clinical Scenario

Used for patients presenting with breast pain to rule out malignancy.

Documentation Requirements

Indications for the mammogram must be documented, including symptoms and any physical findings.

Specialty Considerations

Radiologists should ensure that clinical history is provided to support the necessity of imaging.

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, including mastodynia, which enhances the ability to track and manage breast health issues more effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast conditions, including mastodynia, which enhances the ability to track and manage breast health issues more effectively.

Reimbursement & Billing Impact

reimbursement and to avoid audit issues.

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 the primary cause of mastodynia?

Mastodynia can be caused by hormonal changes, benign breast conditions, or other factors. A thorough evaluation is necessary to determine the underlying cause.