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v1.0.0
ICD-10 Guide
ICD-10 CodesN63.25

N63.25

Billable

Unspecified lump in the left breast, overlapping quadrants

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

Code Description

ICD-10 N63.25 is a billable code used to indicate a diagnosis of unspecified lump in the left breast, overlapping quadrants.

Key Diagnostic Point:

N63.25 refers to an unspecified lump located in the left breast that spans multiple quadrants. This code is often used when a patient presents with a palpable mass that has not been definitively diagnosed as benign or malignant. The lump may arise from various benign breast conditions such as fibrocystic changes, fibroadenomas, or breast hypertrophy. It is crucial to differentiate these lumps from more serious conditions, including breast cancer. The presence of a lump may also be associated with symptoms such as nipple discharge or pain, which can complicate the clinical picture. Imaging studies, including mammography and ultrasound, are typically employed to evaluate the characteristics of the lump and to guide further management. Accurate coding requires thorough documentation of the lump's characteristics, associated symptoms, and any imaging results to ensure appropriate treatment and follow-up.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation of breast lumps
  • Need for detailed documentation of imaging results
  • Differentiation between benign and malignant conditions
  • Potential for overlapping symptoms with other breast conditions

Audit Risk Factors

  • Insufficient documentation of lump characteristics
  • Failure to document imaging studies performed
  • Inconsistent coding of associated symptoms
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with breast lumps requiring biopsy or surgical intervention.

Billing Considerations

Ensure accurate staging and grading of any diagnosed malignancy.

Radiology

Documentation Requirements

Clear imaging reports detailing findings and recommendations.

Common Clinical Scenarios

Imaging studies performed for evaluation of breast lumps.

Billing Considerations

Documentation must specify the imaging modality used and findings related to the lump.

Coding Guidelines

Inclusion Criteria

Use N63.25 When
  • According to ICD
  • 10 guidelines, N63
  • 25 should be used when a lump in the left breast is identified but not specified as benign or malignant
  • Coders should ensure that the documentation supports the diagnosis and that any imaging studies are noted

Exclusion Criteria

Do NOT use N63.25 When
  • Exclusion criteria include cases where the lump is definitively diagnosed as malignant or is part of a known breast condition

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

Documentation of the indication for biopsy and results.

Specialty Considerations

Oncology specialists should ensure that the biopsy results are 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 breast conditions, including the ability to specify the location and characteristics of breast lumps. This has improved the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast conditions, including the ability to specify the location and characteristics of breast lumps. This has improved the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American College of Radiology - Breast Imaging

Coding & Billing References

  • •
    American College of Radiology - Breast Imaging

Frequently Asked Questions

What should be documented when using N63.25?

Documentation should include the characteristics of the lump, any associated symptoms, imaging results, and the clinical decision-making process.