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ICD-10 Guide
ICD-10 CodesN64.51

N64.51

Billable

Induration of breast

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

Code Description

ICD-10 N64.51 is a billable code used to indicate a diagnosis of induration of breast.

Key Diagnostic Point:

Induration of the breast refers to a localized hardening or thickening of breast tissue, which can be a benign condition or indicative of underlying pathology. It is often associated with benign breast diseases such as fibrocystic changes, mastitis, or breast hypertrophy. Induration may present as a palpable lump or area of firmness in the breast, which can be accompanied by symptoms such as pain, tenderness, or nipple discharge. In cases of mastitis, induration may be associated with inflammation and infection, leading to redness and warmth in the affected area. Breast imaging, including mammography and ultrasound, is crucial for evaluating induration, as it helps differentiate between benign and malignant processes. Accurate diagnosis and coding require thorough clinical documentation, including the patient's history, physical examination findings, and imaging results. Understanding the context of induration is essential for appropriate management and follow-up, as it may necessitate further investigation or intervention depending on the underlying cause.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between benign and malignant causes of induration
  • Need for comprehensive documentation of clinical findings
  • Variability in presentation and associated symptoms
  • Potential overlap with other breast conditions

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to include imaging results in the medical record
  • Misclassification of induration as a malignant condition
  • Lack of follow-up documentation for induration

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed history of breast symptoms, imaging results, and biopsy reports if applicable.

Common Clinical Scenarios

Evaluation of induration in patients with a history of breast cancer or suspicious findings on imaging.

Billing Considerations

Need for clear differentiation between benign induration and potential malignancy.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing findings related to induration.

Common Clinical Scenarios

Breast ultrasound or mammography performed to assess induration.

Billing Considerations

Radiologists must correlate imaging findings with clinical symptoms for accurate coding.

Coding Guidelines

Inclusion Criteria

Use N64.51 When
  • According to ICD
  • 10 coding guidelines, N64
  • 51 should be used when induration is specifically documented
  • It is important to include any relevant clinical findings and imaging results to support the diagnosis

Exclusion Criteria

Do NOT use N64.51 When
  • Exclusion criteria include conditions that do not involve induration or are classified under different codes

Related ICD-10 Codes

Related CPT Codes

76090CPT Code

Mammography, bilateral

Clinical Scenario

Used to evaluate induration in the breast.

Documentation Requirements

Include imaging reports and clinical indications for the procedure.

Specialty Considerations

Radiologists should ensure correlation with clinical findings.

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 induration, which enhances the ability to track and manage these conditions effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast conditions, including induration, which enhances the ability to track and manage these conditions effectively.

Reimbursement & Billing Impact

reimbursement and quality reporting.

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 is the primary cause of breast induration?

Breast induration can be caused by various factors, including benign breast diseases, infections like mastitis, or hormonal changes. It is essential to evaluate the induration to determine the underlying cause.