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ICD-10 Guide
ICD-10 CodesChapter 14: Diseases of the genitourinary systemN61

N61

Billable

Inflammatory disorders of breast

Chapter 14:Diseases of the genitourinary system

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

Code Description

ICD-10 N61 is a billable code used to indicate a diagnosis of inflammatory disorders of breast.

Key Diagnostic Point:

Inflammatory disorders of the breast encompass a range of conditions characterized by inflammation of breast tissue. This includes benign breast diseases such as mastitis, which is an infection that can occur during breastfeeding, leading to pain, swelling, and redness. Breast hypertrophy refers to excessive growth of breast tissue, which can cause discomfort and may require surgical intervention. Breast lumps, often benign, can arise from various causes including cysts or fibroadenomas, necessitating imaging studies for evaluation. Nipple discharge can also be a symptom of inflammatory disorders, requiring careful assessment to rule out malignancy. Imaging considerations, such as mammography or ultrasound, are crucial in differentiating between benign and malignant conditions, guiding further management. Accurate coding of these conditions is essential for appropriate treatment and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of conditions under the N61 code
  • Need for precise documentation to differentiate between types of inflammatory disorders
  • Potential overlap with other breast-related codes
  • Variability in clinical presentation and patient history

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the type of inflammatory disorder
  • Misuse of codes for non-inflammatory breast conditions
  • Lack of imaging reports to support diagnosis

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, swelling, or discharge.

Billing Considerations

Ensure to document the duration and characteristics of symptoms for accurate coding.

Radiology

Documentation Requirements

Comprehensive imaging reports and correlation with clinical findings.

Common Clinical Scenarios

Imaging studies performed for breast lumps or abnormal discharge.

Billing Considerations

Clear documentation of imaging findings is essential for coding and billing.

Coding Guidelines

Inclusion Criteria

Use N61 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the specific inflammatory disorder
  • Include any relevant imaging studies and clinical findings to support the diagnosis

Exclusion Criteria

Do NOT use N61 When
  • Exclude conditions that do not meet the criteria for inflammatory disorders

Related CPT Codes

19000CPT Code

Breast biopsy, needle

Clinical Scenario

Used when a breast lump is identified and requires biopsy for diagnosis.

Documentation Requirements

Document the indication for biopsy and imaging results.

Specialty Considerations

Ensure that the specialty performing the biopsy is clearly documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of inflammatory breast disorders, improving the accuracy of diagnosis and treatment tracking. It has also enhanced the ability to capture data on the prevalence of these conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of inflammatory breast disorders, improving the accuracy of diagnosis and treatment tracking. It has also enhanced the ability to capture data on the prevalence of these conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of inflammatory breast disorders, improving the accuracy of diagnosis and treatment tracking. It has also enhanced the ability to capture data on the prevalence of these conditions.

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 are the common symptoms associated with N61?

Common symptoms include breast pain, swelling, redness, warmth, and sometimes discharge from the nipple. Imaging may be required to assess the underlying cause.