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v1.0.0
ICD-10 Guide
ICD-10 CodesN64.89

N64.89

Billable

Other specified disorders of breast

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

Code Description

ICD-10 N64.89 is a billable code used to indicate a diagnosis of other specified disorders of breast.

Key Diagnostic Point:

N64.89 encompasses a variety of benign breast disorders that do not fall under more specific categories. This includes conditions such as benign breast disease, which may present as fibrocystic changes, breast lumps, or other non-cancerous growths. Mastitis, an inflammation of breast tissue, can occur in lactating women and may lead to infection, requiring careful diagnosis and management. Breast hypertrophy refers to excessive breast tissue growth, which can cause physical discomfort and psychological distress. Nipple discharge, which can be physiological or pathological, may indicate underlying conditions that require further investigation. Imaging considerations, such as mammography or ultrasound, are crucial in evaluating these disorders to rule out malignancy and guide treatment. Accurate coding of these conditions is essential for appropriate management and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of conditions included under this code
  • Need for precise documentation to differentiate from malignant conditions
  • Potential for overlapping symptoms with other breast disorders
  • Variability in clinical presentation and imaging findings

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the type of breast disorder
  • Misuse of this code for malignant conditions
  • Inconsistent coding practices across providers

Specialty Focus

Medical Specialties

Breast Surgery

Documentation Requirements

Detailed surgical notes, imaging results, and pathology reports.

Common Clinical Scenarios

Surgical intervention for benign breast lumps or hypertrophy.

Billing Considerations

Ensure clear documentation of the nature of the disorder and any surgical findings.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing findings and recommendations.

Common Clinical Scenarios

Imaging for evaluation of breast lumps or abnormal nipple discharge.

Billing Considerations

Accurate reporting of imaging results is crucial for proper coding.

Coding Guidelines

Inclusion Criteria

Use N64.89 When
  • According to ICD
  • 10 guidelines, N64
  • 89 should be used when a specific diagnosis is not available but the condition is clearly documented
  • Coders should ensure that the documentation supports the diagnosis and that the condition does not fall under more specific codes

Exclusion Criteria

Do NOT use N64.89 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

19301CPT Code

Mastectomy, partial

Clinical Scenario

Used when surgical intervention is required for benign breast disorders.

Documentation Requirements

Surgical notes detailing the procedure and indication.

Specialty Considerations

Breast surgeons must document the specific diagnosis and rationale for surgery.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of breast disorders, improving the accuracy of diagnoses and treatment plans. N64.89 provides a means to capture a variety of benign conditions that may not have been distinctly coded in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast disorders, improving the accuracy of diagnoses and treatment plans. N64.89 provides a means to capture a variety of benign conditions that may not have been distinctly coded in ICD-9.

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 types of conditions are included under N64.89?

N64.89 includes various benign breast disorders such as fibrocystic changes, mastitis, breast hypertrophy, and other specified conditions that do not fall under more specific codes.