ICD-10 Coding for Breast Fibrocystic Disease(N60.19, N60.3)
Complete ICD-10-CM coding and documentation guide for Breast Fibrocystic Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Fibrocystic Disease
N60-N64Primary Range
Disorders of breast
This range includes codes for various benign breast conditions, including fibrocystic changes.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N60.19 | Diffuse cystic mastopathy | Use when documentation confirms diffuse cystic changes without specific mention of fibrosclerosis or epithelial proliferation. |
|
| N60.3 | Fibrosclerosis of breast | Use when documentation specifies fibrosclerosis with epithelial proliferation. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for breast fibrocystic disease
Essential facts and insights about Breast Fibrocystic Disease
Primary ICD-10-CM Codes for breast fibrocystic disease
Decision Criteria
clinical Criteria
- Presence of diffuse cystic changes on imaging
documentation Criteria
- Histologic confirmation of fibrocystic changes
Applicable To
- Fibrocystic changes
- Diffuse cystic changes
Excludes
- Malignant neoplasm of breast (C50.-)
Clinical Validation Requirements
- Histologic confirmation of fibrocystic changes
- Imaging showing diffuse cystic changes
Code-Specific Risks
- Misclassification as malignant neoplasm
- Omission of laterality
Coding Notes
- Ensure documentation specifies 'diffuse cystic changes' to avoid confusion with malignant conditions.
N60.3 - Fibrosclerosis of breast
Use when documentation specifies fibrosclerosis with epithelial proliferation.
Applicable To
- Fibrosclerosis with epithelial proliferation
Excludes
- Malignant neoplasm of breast (C50.-)
Clinical Validation Requirements
- Biopsy showing fibrosclerosis and epithelial proliferation
Coding Notes
Ensure biopsy results are clearly documented to support the use of this code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Inconclusive mammogram
R92.2Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Breast Fibrocystic Disease to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N60.19.
Impact
Clinical: Potential for incorrect treatment planning., Regulatory: Non-compliance with ICD-10 coding rules., Financial: Denied claims due to insufficient specificity.
Mitigation Strategy
Always document the affected breast(s)., Use templates that prompt for laterality.
Impact
Reimbursement: Incorrect DRG assignment leading to potential overpayment., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Verify histologic findings before coding as malignant.
Impact
Using C50 codes for benign conditions like fibrocystic disease.
Mitigation Strategy
Ensure biopsy results confirm malignancy before using C50 codes.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Breast Fibrocystic Disease, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Breast Fibrocystic Disease
Use these documentation templates to ensure complete and accurate documentation for Breast Fibrocystic Disease. These templates include all required elements for proper coding and billing.
Routine examination with fibrocystic changes
Specialty: General SurgeryRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Biopsy results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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