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ICD-10 Guide
ICD-10 CodesN64.3

N64.3

Billable

Galactorrhea not associated with childbirth

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

Code Description

ICD-10 N64.3 is a billable code used to indicate a diagnosis of galactorrhea not associated with childbirth.

Key Diagnostic Point:

Galactorrhea not associated with childbirth is a condition characterized by the spontaneous flow of milk from the breast, which is not related to the physiological process of lactation following childbirth. This condition can occur in both men and women and may be caused by various factors, including hormonal imbalances, medications, and underlying health conditions such as pituitary tumors or hypothyroidism. In women, galactorrhea can be associated with benign breast diseases, such as fibrocystic changes, and may present alongside other symptoms like breast lumps or nipple discharge. The presence of galactorrhea can lead to psychological distress and concerns about breast health, necessitating thorough evaluation and management. Diagnostic imaging, such as mammography or ultrasound, may be employed to assess breast tissue and rule out malignancy or other abnormalities. Understanding the underlying cause of galactorrhea is crucial for effective treatment and management, which may include medication adjustments or hormonal therapy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between physiological and pathological causes of nipple discharge.
  • Need for comprehensive patient history to identify potential hormonal imbalances.
  • Potential overlap with other breast conditions requiring careful documentation.
  • Variability in presentation and associated symptoms complicating diagnosis.

Audit Risk Factors

  • Inadequate documentation of the patient's history and symptoms.
  • Failure to document imaging results or follow-up care.
  • Misclassification of galactorrhea as a symptom of another condition.
  • Lack of clarity on the relationship between galactorrhea and other breast diseases.

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Thorough documentation of hormonal evaluations, including prolactin levels and thyroid function tests.

Common Clinical Scenarios

Patients presenting with galactorrhea and suspected pituitary disorders or hormonal imbalances.

Billing Considerations

Endocrinologists should ensure that all relevant lab results and imaging studies are documented to support the diagnosis.

Radiology

Documentation Requirements

Detailed reports of imaging studies, including mammograms and ultrasounds, with clear indications for the studies.

Common Clinical Scenarios

Imaging performed to evaluate breast lumps or abnormal nipple discharge.

Billing Considerations

Radiologists must correlate imaging findings with clinical symptoms to provide comprehensive reports.

Coding Guidelines

Inclusion Criteria

Use N64.3 When
  • According to the official coding guidelines, N64
  • 3 should be used when galactorrhea is documented without any association with childbirth
  • Coders must ensure that the documentation supports the diagnosis and that any underlying conditions are also coded appropriately

Exclusion Criteria

Do NOT use N64.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

77067CPT Code

Breast ultrasound

Clinical Scenario

Used to evaluate breast lumps or abnormal discharge.

Documentation Requirements

Indication for ultrasound must be clearly documented.

Specialty Considerations

Radiologists should correlate findings with clinical symptoms.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like galactorrhea, improving the accuracy of diagnoses and treatment plans. This specificity aids in better tracking of patient outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like galactorrhea, improving the accuracy of diagnoses and treatment plans. This specificity aids in better tracking of patient outcomes and resource allocation.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Coding & Billing References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Frequently Asked Questions

What are the common causes of galactorrhea?

Common causes include hormonal imbalances, medications (especially antipsychotics), and underlying conditions such as pituitary tumors or hypothyroidism.