ICD-10 Coding for Fibrocystic Breast(N60.19, N60.3)
Complete ICD-10-CM coding and documentation guide for Fibrocystic Breast. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fibrocystic Breast
N60-N64Primary Range
Benign mammary dysplasias
This range includes all 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 for generalized fibrocystic changes with multiple cysts, confirmed by imaging and pathology. |
|
| N60.3 | Fibrosclerosis | Use when documentation specifies dominant stromal fibrosis. |
|
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
Essential facts and insights about Fibrocystic Breast
Primary ICD-10-CM Codes for fibrocystic breast
Decision Criteria
clinical Criteria
- Presence of multiple cysts confirmed by imaging
documentation Criteria
- Pathology report confirming non-proliferative changes
Applicable To
- Bilateral fibrocystic changes
- Multiple cysts
Clinical Validation Requirements
- Imaging confirmation of multiple cysts
- Pathology confirmation of non-proliferative changes
Code-Specific Risks
- Misclassification due to lack of imaging confirmation
- Use of outdated terminology
Coding Notes
- Ensure laterality is documented and avoid using unspecified codes.
N60.3 - Fibrosclerosis
Use when documentation specifies dominant stromal fibrosis.
Applicable To
- Stromal fibrosis
Excludes
- Diffuse cystic mastopathy (N60.19)
Clinical Validation Requirements
- Pathology confirmation of dense collagenous stroma
Coding Notes
Ensure documentation specifies fibrosis as the primary finding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Fibrocystic Breast 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 miscommunication among healthcare providers., Regulatory: Non-compliance with current coding standards., Financial: Potential for denied claims due to lack of specificity.
Mitigation Strategy
Use current terminology such as 'diffuse cystic mastopathy'.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with specificity requirements., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Ensure imaging and pathology confirm specific diagnosis to use N60.19 or N60.3.
Impact
Failure to document laterality can lead to audit issues.
Mitigation Strategy
Ensure laterality is documented in all clinical notes and imaging reports.
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, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fibrocystic Breast
Use these documentation templates to ensure complete and accurate documentation for Fibrocystic Breast. These templates include all required elements for proper coding and billing.
Routine Breast Exam with Fibrocystic Changes
Specialty: GynecologyRequired Elements
- Breast consistency
- Tenderness
- Imaging correlation
- Pathology confirmation
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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