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v1.0.0
ICD-10 Guide
ICD-10 CodesN63.14

N63.14

Billable

Unspecified lump in the right breast, lower inner quadrant

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

Code Description

ICD-10 N63.14 is a billable code used to indicate a diagnosis of unspecified lump in the right breast, lower inner quadrant.

Key Diagnostic Point:

N63.14 refers to an unspecified lump located in the lower inner quadrant of the right breast. This code is often used when a patient presents with a palpable mass that has not been definitively diagnosed as benign or malignant. The differential diagnosis for breast lumps includes benign breast diseases such as fibrocystic changes, fibroadenomas, and lipomas, as well as conditions like mastitis or breast hypertrophy. The clinical evaluation typically involves a thorough history and physical examination, followed by imaging studies such as mammography or ultrasound to assess the characteristics of the lump. Nipple discharge may also be evaluated, as it can provide additional diagnostic clues. Accurate coding requires careful documentation of the lump's characteristics, any associated symptoms, and the results of imaging studies. This code is essential for tracking breast health and ensuring appropriate follow-up care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of lump characteristics
  • Need for imaging results to support diagnosis
  • Differential diagnosis considerations
  • Potential for benign vs malignant interpretation

Audit Risk Factors

  • Insufficient documentation of clinical findings
  • Lack of imaging results in the medical record
  • Inconsistent terminology used in documentation
  • Failure to specify the nature of the lump

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed imaging reports and pathology results if biopsy is performed.

Common Clinical Scenarios

Patients presenting with breast lumps requiring further evaluation for malignancy.

Billing Considerations

Ensure clear documentation of the clinical decision-making process and follow-up plans.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing findings and recommendations.

Common Clinical Scenarios

Imaging studies performed to evaluate breast lumps.

Billing Considerations

Radiologists should ensure that imaging findings correlate with clinical notes.

Coding Guidelines

Inclusion Criteria

Use N63.14 When
  • According to ICD
  • 10 guidelines, N63
  • 14 should be used when the lump is not specified as benign or malignant
  • Coders must ensure that the documentation supports the use of this code and that it aligns with the clinical findings

Exclusion Criteria

Do NOT use N63.14 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

77067CPT Code

Mammography, bilateral

Clinical Scenario

Used when imaging is performed to evaluate the lump.

Documentation Requirements

Mammography report must be included in the medical record.

Specialty Considerations

Radiologists should ensure that findings are clearly communicated to the referring physician.

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 ability to track and manage breast health. N63.14 provides a clear designation for unspecified lumps, facilitating appropriate care and follow-up.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast conditions, improving the ability to track and manage breast health. N63.14 provides a clear designation for unspecified lumps, facilitating appropriate care and follow-up.

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 should be documented to support the use of N63.14?

Documentation should include a detailed description of the lump, any associated symptoms, imaging results, and follow-up plans. Clear clinical notes that correlate with the diagnosis are essential.