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v1.0.0
ICD-10 Guide
ICD-10 CodesD48.60

D48.60

Billable

Neoplasm of uncertain behavior of unspecified breast

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 D48.60 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of unspecified breast.

Key Diagnostic Point:

D48.60 refers to a neoplasm of uncertain behavior located in the breast, where the specific nature of the tumor cannot be definitively classified as benign or malignant. This code is used when there is insufficient information to determine the behavior of the neoplasm, which may include atypical hyperplasia or other indeterminate lesions. These neoplasms can present a challenge in clinical management due to their potential for progression to malignancy. Surveillance is crucial, as these lesions may require regular monitoring through imaging or biopsy to assess any changes in behavior. The uncertainty surrounding these neoplasms necessitates a multidisciplinary approach, often involving oncologists, radiologists, and pathologists, to ensure appropriate management and follow-up. The clinical implications of a diagnosis of D48.60 can vary widely, and patient education about the nature of the neoplasm and the importance of follow-up is essential.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Uncertainty in behavior classification
  • Need for comprehensive documentation
  • Potential for progression to malignancy
  • Variability in clinical presentation

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document follow-up plans
  • Misclassification of neoplasm behavior
  • Lack of multidisciplinary notes

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Monitoring of patients with uncertain breast neoplasms, decision-making regarding biopsy or surgical intervention.

Billing Considerations

Ensure all findings are documented, including patient discussions about risks and benefits of surveillance.

Radiology

Documentation Requirements

Imaging reports that detail findings and recommendations for follow-up.

Common Clinical Scenarios

Performing mammograms or ultrasounds on patients with D48.60 for surveillance.

Billing Considerations

Clear communication of imaging findings to referring physicians is critical.

Coding Guidelines

Inclusion Criteria

Use D48.60 When
  • According to ICD
  • 10 coding guidelines, D48
  • 60 should be used when the neoplasm's behavior is uncertain and cannot be classified as benign or malignant
  • Coders should ensure that the diagnosis is supported by clinical documentation and that any follow
  • up plans are clearly outlined

Exclusion Criteria

Do NOT use D48.60 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

88305CPT Code

Pathology examination, surgical

Clinical Scenario

Used when a biopsy is performed on a breast lesion with uncertain behavior.

Documentation Requirements

Pathology report must clearly indicate the findings and the nature of the neoplasm.

Specialty Considerations

Oncologists should ensure that pathology findings are discussed in the context of treatment planning.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior. D48.60 provides a distinct code for neoplasms that do not fit neatly into benign or malignant categories, facilitating better tracking and management of these cases.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior. D48.60 provides a distinct code for neoplasms that do not fit neatly into benign or malignant categories, facilitating better tracking and management of these cases.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior. D48.60 provides a distinct code for neoplasms that do not fit neatly into benign or malignant categories, facilitating better tracking and management of these cases.

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 does D48.60 indicate?

D48.60 indicates a neoplasm of uncertain behavior in the breast, where the specific nature of the tumor cannot be classified as benign or malignant.

When should D48.60 be used?

D48.60 should be used when there is insufficient information to classify a breast neoplasm as benign or malignant, and ongoing surveillance is required.

What are the implications of a D48.60 diagnosis?

A diagnosis of D48.60 indicates the need for careful monitoring and potential intervention, as these neoplasms may progress to malignancy.