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v1.0.0
ICD-10 Guide
ICD-10 CodesN64.53

N64.53

Billable

Retraction of nipple

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

Code Description

ICD-10 N64.53 is a billable code used to indicate a diagnosis of retraction of nipple.

Key Diagnostic Point:

Retraction of the nipple is a condition characterized by the inward pulling or retraction of the nipple, which can occur due to various underlying causes. This condition may be benign or indicative of more serious issues, such as malignancy. Commonly associated with benign breast diseases, nipple retraction can arise from conditions like mastitis, which is an infection of the breast tissue, or from breast hypertrophy, where excessive breast tissue can lead to structural changes. Additionally, breast lumps and nipple discharge may accompany retraction, necessitating thorough evaluation. Imaging studies, such as mammography or ultrasound, are often employed to assess the underlying causes of nipple retraction, especially when there are concerning features such as unilateral retraction or associated masses. Accurate diagnosis and coding are crucial, as the presence of nipple retraction can significantly influence treatment decisions and patient management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between benign and malignant causes of retraction
  • Need for comprehensive documentation of associated symptoms
  • Variability in clinical presentation among patients
  • Potential overlap with other breast conditions requiring precise coding

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to include imaging results in the medical record
  • Misclassification of the cause of retraction
  • Lack of follow-up documentation for ongoing conditions

Specialty Focus

Medical Specialties

Breast Surgery

Documentation Requirements

Detailed clinical notes including physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Evaluation of patients with nipple retraction and associated breast lumps or discharge.

Billing Considerations

Ensure clear documentation of the relationship between nipple retraction and any identified masses or lesions.

Radiology

Documentation Requirements

Comprehensive imaging reports that detail findings related to nipple retraction.

Common Clinical Scenarios

Performing mammograms or ultrasounds in patients presenting with nipple retraction.

Billing Considerations

Radiologists should correlate imaging findings with clinical symptoms to support accurate coding.

Coding Guidelines

Inclusion Criteria

Use N64.53 When
  • According to official coding guidelines, N64
  • 53 should be used when the clinical documentation supports the diagnosis of nipple retraction
  • It is important to include any associated symptoms or findings, such as discharge or lumps, to ensure accurate coding

Exclusion Criteria

Do NOT use N64.53 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

19281CPT Code

Breast biopsy, needle core

Clinical Scenario

When a biopsy is performed due to suspicious findings associated with nipple retraction.

Documentation Requirements

Document the indication for biopsy and findings from imaging studies.

Specialty Considerations

Breast surgeons should ensure that the reason for the biopsy is clearly linked to the diagnosis of nipple retraction.

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 nipple retraction, 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 nipple retraction, improving the accuracy of diagnoses and treatment plans. This specificity aids in better tracking of patient outcomes and resource allocation.

Reimbursement & Billing Impact

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

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 are the common causes of nipple retraction?

Common causes include benign breast diseases, mastitis, breast hypertrophy, and malignancy. Each cause may present differently and requires thorough evaluation.