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v1.0.0
ICD-10 Guide
ICD-10 CodesN63.24

N63.24

Billable

Unspecified lump in the left breast, lower inner quadrant

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

Code Description

ICD-10 N63.24 is a billable code used to indicate a diagnosis of unspecified lump in the left breast, lower inner quadrant.

Key Diagnostic Point:

N63.24 refers to an unspecified lump located in the lower inner quadrant of the left 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 breast hypertrophy, as well as inflammatory conditions like mastitis. The clinical evaluation typically involves a thorough history and physical examination, followed by imaging studies such as mammography or ultrasound to characterize the lump. In cases where the lump is associated with nipple discharge, further investigation may be warranted to rule out underlying pathology. Accurate coding is essential for appropriate management and reimbursement, and it requires careful documentation of the clinical findings and any imaging results. The unspecified nature of this code indicates that further diagnostic workup may be necessary to clarify the nature of the lump.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified nature of the lump requires additional diagnostic clarification.
  • Potential overlap with other breast conditions complicates coding.
  • Need for precise documentation to support the diagnosis.
  • Variability in clinical presentation and imaging findings.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to provide imaging results or follow-up plans.
  • Misclassification of benign versus malignant lumps.
  • Lack of specificity in the diagnosis leading to potential denials.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed history of the lump, imaging results, and any biopsy findings.

Common Clinical Scenarios

Patients presenting with a new breast lump, abnormal imaging results, or a family history of breast cancer.

Billing Considerations

Ensure that all findings are documented to support the diagnosis and any subsequent treatment plans.

Radiology

Documentation Requirements

Clear imaging reports detailing the characteristics of the lump and any recommendations for further evaluation.

Common Clinical Scenarios

Imaging studies performed for palpable breast lumps or abnormal mammograms.

Billing Considerations

Radiologists should provide comprehensive reports that correlate imaging findings with clinical symptoms.

Coding Guidelines

Inclusion Criteria

Use N63.24 When
  • According to ICD
  • 10 coding guidelines, N63
  • 24 should be used when a lump is identified but not specified as benign or malignant
  • Coders should ensure that the documentation supports the diagnosis and that any relevant imaging studies are included in the medical record

Exclusion Criteria

Do NOT use N63.24 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

19100CPT Code

Biopsy of breast, needle core

Clinical Scenario

Used when a lump is biopsied to determine its nature.

Documentation Requirements

Document the indication for the biopsy and the findings.

Specialty Considerations

Oncologists and radiologists should ensure that the biopsy results are clearly linked to the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding breast conditions. N63.24 provides a clear designation for unspecified lumps, which can help in tracking and managing breast health more effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding breast conditions. N63.24 provides a clear designation for unspecified lumps, which can help in tracking and managing breast health more effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding breast conditions. N63.24 provides a clear designation for unspecified lumps, which can help in tracking and managing breast health more effectively.

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 I document when coding N63.24?

Document the location of the lump, any associated symptoms, imaging results, and follow-up plans to support the diagnosis.