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v1.0.0
ICD-10 Guide
ICD-10 CodesN64.59

N64.59

Billable

Other signs and symptoms in breast

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

Code Description

ICD-10 N64.59 is a billable code used to indicate a diagnosis of other signs and symptoms in breast.

Key Diagnostic Point:

N64.59 encompasses a variety of benign breast conditions that present with signs and symptoms not classified elsewhere. This includes benign breast disease, which may manifest as fibrocystic changes, breast lumps, or tenderness. Mastitis, an infection of the breast tissue, can lead to swelling, redness, and pain, often accompanied by fever. Breast hypertrophy refers to excessive breast tissue growth, which can cause discomfort and psychosocial issues. Nipple discharge, whether clear, bloody, or milky, can indicate underlying pathology or hormonal imbalances. Imaging considerations are crucial, as mammograms or ultrasounds may be necessary to evaluate breast lumps or abnormal findings. Accurate diagnosis and documentation are essential for appropriate coding and management of these conditions, as they can significantly impact patient care and treatment options.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of symptoms that can overlap with other conditions
  • Need for thorough documentation to differentiate between benign and malignant conditions
  • Potential for multiple diagnoses related to breast symptoms
  • Variability in clinical presentation among patients

Audit Risk Factors

  • Inadequate documentation of symptoms leading to misclassification
  • Failure to include imaging results in the medical record
  • Inconsistent use of terminology in documentation
  • Lack of clarity regarding the nature of nipple discharge

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed history of breast symptoms, imaging results, and any previous treatments.

Common Clinical Scenarios

Patients presenting with breast lumps or abnormal imaging findings.

Billing Considerations

Need for clear differentiation between benign and malignant conditions to avoid misdiagnosis.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing findings and recommendations.

Common Clinical Scenarios

Performing mammograms or ultrasounds for patients with breast symptoms.

Billing Considerations

Ensuring imaging findings correlate with clinical symptoms for accurate coding.

Coding Guidelines

Inclusion Criteria

Use N64.59 When
  • According to ICD
  • 10 guidelines, N64
  • 59 should be used when specific symptoms in the breast do not fit into other defined categories
  • Coders must ensure that documentation supports the diagnosis and that all relevant symptoms are captured

Exclusion Criteria

Do NOT use N64.59 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

77067CPT Code

Mammography, bilateral

Clinical Scenario

Used for screening or diagnostic evaluation of breast symptoms.

Documentation Requirements

Indication for the procedure and results of prior imaging.

Specialty Considerations

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

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, improving the ability to capture the complexity of symptoms and their management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast conditions, improving the ability to capture the complexity of symptoms and their management.

Reimbursement & Billing Impact

reimbursement and compliance.

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 symptoms are included under N64.59?

N64.59 includes a variety of benign breast symptoms such as lumps, nipple discharge, and signs of mastitis, among others.