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v1.0.0
ICD-10 Guide
ICD-10 CodesN64.8

N64.8

Billable

Other specified disorders of breast

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

Code Description

ICD-10 N64.8 is a billable code used to indicate a diagnosis of other specified disorders of breast.

Key Diagnostic Point:

N64.8 encompasses a variety of benign breast conditions that do not fall under more specific categories. This includes benign breast diseases such as fibrocystic changes, which can lead to breast lumps and discomfort. Mastitis, an infection of the breast tissue, is another condition that may be coded under N64.8, particularly in lactating women. Breast hypertrophy, characterized by excessive breast tissue growth, can also be included, often leading to physical discomfort and psychological distress. Nipple discharge, which may be spontaneous or associated with other breast conditions, is another symptom that can be coded under this classification. Imaging studies, such as mammograms or ultrasounds, are often utilized to evaluate these conditions, and the findings can influence the coding process. Accurate documentation of symptoms, imaging results, and clinical findings is crucial for proper coding and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of conditions included under the code
  • Need for precise documentation to differentiate between conditions
  • Potential overlap with other breast-related codes
  • Variability in clinical presentation and symptoms

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the type of breast disorder
  • Misuse of the code for conditions that have specific codes
  • Lack of imaging documentation to support diagnosis

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Detailed patient history, physical examination findings, and imaging results.

Common Clinical Scenarios

Patients presenting with breast lumps, nipple discharge, or breast pain.

Billing Considerations

Ensure that all symptoms and findings are documented to support the use of N64.8.

Radiology

Documentation Requirements

Imaging reports, including mammograms and ultrasounds, must be clearly documented.

Common Clinical Scenarios

Imaging studies performed for breast lumps or abnormal findings.

Billing Considerations

Radiologists should ensure that findings correlate with clinical symptoms for accurate coding.

Coding Guidelines

Inclusion Criteria

Use N64.8 When
  • According to ICD
  • 10 guidelines, N64
  • 8 should be used when the specific disorder of the breast is not classified elsewhere
  • Coders must ensure that the documentation supports the use of this code and that it is not used for conditions with more specific codes

Exclusion Criteria

Do NOT use N64.8 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 conditions.

Documentation Requirements

Mammography reports must be included in the patient's medical record.

Specialty Considerations

Radiologists should ensure that 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 disorders, but N64.8 remains a necessary code for conditions that do not fit into more defined categories. Coders must be diligent in documenting the specifics of each case to ensure appropriate coding.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast disorders, but N64.8 remains a necessary code for conditions that do not fit into more defined categories. Coders must be diligent in documenting the specifics of each case to ensure appropriate coding.

Reimbursement & Billing Impact

reimbursement.

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 conditions are included under N64.8?

N64.8 includes various benign breast disorders such as fibrocystic changes, mastitis, breast hypertrophy, and nipple discharge that do not fall under more specific codes.