ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesN64.5

N64.5

Billable

Other signs and symptoms in breast

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

Code Description

ICD-10 N64.5 is a billable code used to indicate a diagnosis of other signs and symptoms in breast.

Key Diagnostic Point:

N64.5 encompasses a variety of benign breast conditions that present with symptoms such as lumps, discharge, or changes in breast tissue. Common benign breast diseases include fibrocystic changes, which can cause breast pain and lumpiness, and breast hypertrophy, characterized by excessive breast tissue growth. Mastitis, an infection of the breast tissue, can lead to swelling, redness, and discharge, particularly in lactating women. Nipple discharge can be physiological or pathological, necessitating careful evaluation to rule out malignancy. Imaging studies, such as mammography and ultrasound, are often employed to assess breast lumps and other abnormalities, guiding further management. Accurate coding requires a thorough understanding of the presenting symptoms and associated conditions, as well as the clinical context in which they occur.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of benign conditions that can present with similar symptoms
  • Need for detailed clinical documentation to differentiate between conditions
  • Potential overlap with malignant conditions requiring careful evaluation
  • Variability in imaging findings and their interpretation

Audit Risk Factors

  • Inadequate documentation of symptoms leading to misdiagnosis
  • Failure to specify the type of discharge or lump
  • Lack of imaging results in the medical record
  • Inconsistent terminology used in documentation

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed history of breast symptoms, imaging results, and any biopsies performed.

Common Clinical Scenarios

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

Billing Considerations

Need for clear differentiation between benign and malignant findings.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing findings and recommendations.

Common Clinical Scenarios

Follow-up imaging for previously identified breast abnormalities.

Billing Considerations

Accurate coding based on imaging findings is crucial for reimbursement.

Coding Guidelines

Inclusion Criteria

Use N64.5 When
  • According to official coding guidelines, N64
  • 5 should be used when the clinical documentation supports the diagnosis of other signs and symptoms in the breast that do not fit into more specific categories
  • Coders should ensure that the documentation clearly outlines the symptoms and any relevant diagnostic tests performed

Exclusion Criteria

Do NOT use N64.5 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

77067CPT Code

Mammography, bilateral

Clinical Scenario

Used for screening or diagnostic evaluation of breast symptoms.

Documentation Requirements

Must include indication for the study and findings.

Specialty Considerations

Radiologists should ensure that findings correlate 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 granularity of data for research and treatment outcomes. N64.5 provides a distinct code for benign breast symptoms, facilitating better tracking and management of these conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast conditions, improving the granularity of data for research and treatment outcomes. N64.5 provides a distinct code for benign breast symptoms, facilitating better tracking and management of these conditions.

Reimbursement & Billing Impact

reimbursement.

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 symptoms are included under N64.5?

N64.5 includes symptoms such as breast lumps, nipple discharge, and breast pain that do not fit into more specific categories.

How do I differentiate between benign and malignant breast conditions?

Differentiation typically involves clinical examination, imaging studies, and sometimes biopsy. Documentation should clearly outline findings and any follow-up actions.