ICD-10 Coding for Breast Tenderness(N64.4)
Complete ICD-10-CM coding and documentation guide for Breast Tenderness. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Tenderness
N60-N64Primary Range
Disorders of breast
This range includes codes for various breast disorders, including mastodynia (N64.4), which is the primary code for breast tenderness.
Pain, not elsewhere classified
Used when the encounter is primarily for pain management, with codes like G89.11 for acute pain.
Key Information: ICD-10 code for breast tenderness
Essential facts and insights about Breast Tenderness
Primary ICD-10-CM Code for breast tenderness
Decision Criteria
clinical Criteria
- Presence of breast tenderness without masses or other identifiable pathology.
documentation Criteria
- Detailed documentation of laterality and cyclical nature.
Clinical Validation Requirements
- Documentation of laterality and quadrant
- Cyclical vs non-cyclical pattern
- Associated symptoms and findings
Code-Specific Risks
- Confusion with chest pain codes
- Lack of laterality leading to denials
Coding Notes
- Ensure documentation specifies laterality and quadrant to avoid unspecified coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Acute pain due to trauma
G89.11Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Chest pain on breathing
R07.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Breast Tenderness to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N64.4.
Impact
Clinical: Leads to incomplete clinical assessment., Regulatory: Non-compliance with ICD-10 coding guidelines., Financial: Potential for claim denials.
Mitigation Strategy
Train staff on the importance of detailed documentation., Use templates that prompt for laterality.
Impact
Reimbursement: May lead to denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Impacts the accuracy of clinical data.
Mitigation Strategy
Ensure documentation includes laterality and quadrant details.
Impact
Using unspecified codes when specific details are available.
Mitigation Strategy
Ensure documentation includes all required details such as laterality and quadrant.
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 Tenderness, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Breast Tenderness
Use these documentation templates to ensure complete and accurate documentation for Breast Tenderness. These templates include all required elements for proper coding and billing.
Cyclical Breast Tenderness
Specialty: OB/GYNRequired Elements
- Laterality
- Cyclical pattern
- Associated findings
- Palpation details
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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