ICD-10 Coding for Fibrocystic Breast Disease(N60.3, N60.19)
Complete ICD-10-CM coding and documentation guide for Fibrocystic Breast Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fibrocystic Breast Disease
N60-N64Primary Range
Disorders of breast
This range includes codes for 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 |
|---|---|---|---|
| N60.3 | Fibrosclerosis of breast | Use when fibrosclerosis is confirmed via biopsy and imaging supports epithelial proliferation. |
|
| N60.19 | Other benign mammary dysplasia | Use for benign breast changes without 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 fibrocystic breast disease
Essential facts and insights about Fibrocystic Breast Disease
Primary ICD-10-CM Codes for fibrocystic breast disease
Decision Criteria
clinical Criteria
- Biopsy confirms fibrosclerosis with epithelial proliferation.
documentation Criteria
- Laterality and specific quadrant must be documented.
Applicable To
- Fibrocystic mastopathy with epithelial proliferation
Excludes
- Benign neoplasm of breast (D24.-)
Clinical Validation Requirements
- Biopsy confirmation of fibrosclerosis
- Imaging showing complex cysts with epithelial proliferation
Code-Specific Risks
- Confusing with benign neoplasm codes
- Missing laterality in documentation
Coding Notes
- Ensure documentation specifies epithelial proliferation and laterality.
N60.19 - Other benign mammary dysplasia
Use for benign breast changes without epithelial proliferation.
Applicable To
- Diffuse cystic mastopathy
Excludes
- Fibrosclerosis of breast (N60.3)
Clinical Validation Requirements
- Clinical exam showing generalized breast nodularity
- Imaging without epithelial proliferation
Coding Notes
Ensure documentation differentiates from fibrosclerosis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Inconclusive mammogram
R92.2Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fibrocystic Breast Disease to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N60.3.
Impact
Clinical: Inaccurate treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always document laterality in clinical notes, Use templates that prompt for laterality
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Verify biopsy results and use N60.3 if epithelial proliferation is confirmed.
Impact
Lack of biopsy documentation for fibrosclerosis cases.
Mitigation Strategy
Implement mandatory biopsy documentation protocols.
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 Disease, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fibrocystic Breast Disease
Use these documentation templates to ensure complete and accurate documentation for Fibrocystic Breast Disease. These templates include all required elements for proper coding and billing.
Fibrosclerosis with epithelial proliferation
Specialty: RadiologyRequired Elements
- Imaging findings
- Biopsy results
- Laterality
- Quadrant location
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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