ICD-10 Coding for Breast Pain(N64.4)
Complete ICD-10-CM coding and documentation guide for Breast Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Pain
N60-N64Primary Range
Noninflammatory disorders of breast
This range includes codes for various noninflammatory breast disorders, including mastodynia (N64.4), which is the primary code for breast pain.
Inflammatory disorders of breast
This range includes codes for inflammatory conditions like mastitis, which can also cause breast pain.
Key Information: ICD-10 code for breast pain
Essential facts and insights about Breast Pain
Primary ICD-10-CM Code for breast pain
Decision Criteria
clinical Criteria
- Pain is cyclical and correlates with menstrual cycle.
coding Criteria
- No underlying condition like infection or neoplasm is present.
Applicable To
- Breast pain
Excludes
- Breast pain due to prosthesis complications (T85.4)
Clinical Validation Requirements
- Negative imaging results
- Absence of palpable mass
- Exclusion of other conditions like infection or neoplasm
Code-Specific Risks
- Using N64.4 when there is an underlying condition like mastitis.
Coding Notes
- Ensure documentation specifies cyclical vs. non-cyclical nature of pain.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for screening mammogram
Z01.419Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Breast Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N64.4.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Ensure imaging results are included in the patient's record., Verify documentation before coding.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on breast pain prevalence.
Mitigation Strategy
Code N61.0 for mastitis first.
Impact
Using N64.4 when an underlying condition is present.
Mitigation Strategy
Review clinical documentation for underlying conditions.
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 Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Breast Pain
Use these documentation templates to ensure complete and accurate documentation for Breast Pain. These templates include all required elements for proper coding and billing.
Cyclical breast pain in OB/GYN
Specialty: OB/GYNRequired Elements
- History of present illness
- Physical examination findings
- Imaging results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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