ICD-10 Coding for Fibrocystic Breast Changes(N60.19, N60.11, N60.12)
Complete ICD-10-CM coding and documentation guide for Fibrocystic Breast Changes. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fibrocystic Breast Changes
N60.0-N60.9Primary Range
Benign Mammary Dysplasias
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, Unspecified | Use when fibrocystic changes are present without epithelial proliferation. |
|
| N60.11 | Diffuse Cystic Mastopathy, Right Breast | Use when fibrocystic changes are confirmed in the right breast. |
|
| N60.12 | Diffuse Cystic Mastopathy, Left Breast | Use when fibrocystic changes are confirmed in the left breast. |
|
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 fibrocystic breast changes
Essential facts and insights about Fibrocystic Breast Changes
Primary ICD-10-CM Codes for fibrocystic breast changes
Decision Criteria
clinical Criteria
- Presence of multiple cysts without epithelial proliferation
documentation Criteria
- Documentation of cysts and absence of atypia
Applicable To
- Fibrocystic breast changes without epithelial proliferation
Excludes
- N60.3- (Fibrocystic changes with epithelial proliferation)
Clinical Validation Requirements
- Ultrasound showing multiple cysts
- Mammogram indicating dense breast tissue
- Absence of atypia on biopsy
Code-Specific Risks
- Risk of unspecified laterality leading to denials
Coding Notes
- Ensure laterality is specified to avoid unspecified coding.
N60.11 - Diffuse Cystic Mastopathy, Right Breast
Use when fibrocystic changes are confirmed in the right breast.
Applicable To
- Right breast fibrocystic changes
Excludes
- N60.3- (Fibrocystic changes with epithelial proliferation)
Clinical Validation Requirements
- Ultrasound confirming right breast cysts
- Mammogram indicating right breast density
Coding Notes
Ensure right breast involvement is documented.
N60.12 - Diffuse Cystic Mastopathy, Left Breast
Use when fibrocystic changes are confirmed in the left breast.
Applicable To
- Left breast fibrocystic changes
Excludes
- N60.3- (Fibrocystic changes with epithelial proliferation)
Clinical Validation Requirements
- Ultrasound confirming left breast cysts
- Mammogram indicating left breast density
Coding Notes
Ensure left breast involvement is documented.
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.
Fibrocystic Changes with Epithelial Proliferation
N60.3-Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fibrocystic Breast Changes to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N60.19.
Impact
Clinical: May lead to misinterpretation of clinical findings., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Use templates that prompt for laterality, Review documentation for completeness before submission
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Always specify laterality when coding fibrocystic changes.
Impact
Reimbursement: Incorrect coding may affect DRG assignment., Compliance: Potential for audit issues., Data Quality: Impacts clinical data integrity.
Mitigation Strategy
Differentiate fibrocystic changes from benign neoplasms through imaging and biopsy.
Impact
Failure to document laterality can lead to audit issues.
Mitigation Strategy
Implement mandatory fields for laterality in EHR templates.
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 Fibrocystic Breast Changes, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fibrocystic Breast Changes
Use these documentation templates to ensure complete and accurate documentation for Fibrocystic Breast Changes. These templates include all required elements for proper coding and billing.
Routine Evaluation of Fibrocystic Changes
Specialty: RadiologyRequired Elements
- Breast density assessment
- Cyst size and location
- BI-RADS classification
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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