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v1.0.0
ICD-10 Guide
ICD-10 CodesN64.82

N64.82

Billable

Hypoplasia of breast

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

Code Description

ICD-10 N64.82 is a billable code used to indicate a diagnosis of hypoplasia of breast.

Key Diagnostic Point:

Hypoplasia of the breast refers to an underdevelopment or incomplete development of breast tissue. This condition can manifest as a significant reduction in breast size and volume, which may be unilateral or bilateral. Hypoplasia can occur due to genetic factors, hormonal imbalances, or developmental issues during puberty. Clinically, patients may present with concerns regarding breast aesthetics, potential implications for breastfeeding, or associated psychological impacts. It is essential to differentiate hypoplasia from other breast conditions such as hypertrophy, lumps, or mastitis, as these may present with overlapping symptoms. Imaging studies, including mammography and ultrasound, may be utilized to assess breast tissue density and rule out other pathologies. Accurate diagnosis and coding are crucial for appropriate management and treatment planning, which may include surgical interventions or counseling regarding breast development and health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other breast conditions such as hypertrophy and lumps.
  • Potential for co-occurring conditions that may complicate diagnosis.
  • Variability in clinical presentation and patient reporting.
  • Need for comprehensive documentation to support diagnosis.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to specify laterality (unilateral vs. bilateral).
  • Misdiagnosis due to overlapping symptoms with other breast conditions.
  • Lack of imaging studies to support diagnosis.

Specialty Focus

Medical Specialties

Breast Surgery

Documentation Requirements

Detailed clinical notes, imaging results, and treatment plans.

Common Clinical Scenarios

Patients seeking surgical intervention for breast augmentation or reconstruction.

Billing Considerations

Ensure clear documentation of the patient's history and physical examination findings.

Endocrinology

Documentation Requirements

Hormonal assessment results and treatment history.

Common Clinical Scenarios

Patients with hormonal imbalances affecting breast development.

Billing Considerations

Document any endocrine evaluations that may contribute to breast hypoplasia.

Coding Guidelines

Inclusion Criteria

Use N64.82 When
  • According to ICD
  • 10 coding guidelines, N64
  • 82 should be used when there is clear documentation of breast hypoplasia
  • It is essential to include details about the extent of hypoplasia and any associated symptoms

Exclusion Criteria

Do NOT use N64.82 When
  • Exclusion criteria include conditions that are not classified as hypoplasia, such as breast cancer or other malignancies

Related ICD-10 Codes

Related CPT Codes

19316CPT Code

Breast augmentation

Clinical Scenario

When a patient with hypoplasia seeks surgical enhancement.

Documentation Requirements

Pre-operative assessment, patient consent, and surgical notes.

Specialty Considerations

Breast surgeons should document the rationale for surgery related to hypoplasia.

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 hypoplasia. This specificity aids in better tracking of patient outcomes and resource allocation for treatment.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast conditions, including hypoplasia. This specificity aids in better tracking of patient outcomes and resource allocation for treatment.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of breast conditions, including hypoplasia. This specificity aids in better tracking of patient outcomes and resource allocation for treatment.

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 breast hypoplasia?

Breast hypoplasia can be caused by genetic factors, hormonal imbalances, or developmental issues during puberty. It is essential to evaluate each patient individually to determine the underlying cause.