ICD-10 Coding for Lump on Breast(N63.0, N63.11)
Complete ICD-10-CM coding and documentation guide for Lump on Breast. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lump on Breast
N63Primary Range
Unspecified lump in breast
This range covers unspecified lumps in the breast, including those not yet diagnosed as benign or malignant.
Abnormal and inconclusive findings on diagnostic imaging of breast
This range is used for imaging findings that are abnormal or inconclusive, often used in conjunction with N63 codes.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N63.0 | Unspecified lump in unspecified breast | Use when the breast lump is unspecified in terms of laterality and quadrant. |
|
| N63.11 | Unspecified lump in right breast, upper outer quadrant | Use when the lump is located in the right breast's upper outer quadrant. |
|
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 breast lump
Essential facts and insights about Lump on Breast
Primary ICD-10-CM Codes for lump on breast
Decision Criteria
documentation Criteria
- Lack of specific quadrant or laterality
Clinical Validation Requirements
- Physical examination indicating a lump
- Lack of specific quadrant or laterality information
Code-Specific Risks
- Risk of claim denial due to lack of specificity
Coding Notes
- Ensure to query for more specific information if available.
N63.11 - Unspecified lump in right breast, upper outer quadrant
Use when the lump is located in the right breast's upper outer quadrant.
Excludes
- Malignant neoplasm of breast (C50.-)
- Benign neoplasm of breast (D24.-)
Clinical Validation Requirements
- Physical examination indicating a lump in the specified quadrant
- Documentation of laterality and quadrant
Coding Notes
Ensure detailed documentation of the lump's characteristics.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Lump on Breast to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N63.0.
Impact
Clinical: Inaccurate clinical records., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always include laterality in clinical notes., Use templates that prompt for laterality.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Poor data quality and inaccurate clinical records.
Mitigation Strategy
Always document and code the specific quadrant and laterality.
Impact
Frequent use of unspecified codes can trigger audits.
Mitigation Strategy
Ensure detailed documentation and use specific codes.
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 Lump on Breast, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lump on Breast
Use these documentation templates to ensure complete and accurate documentation for Lump on Breast. These templates include all required elements for proper coding and billing.
Breast lump evaluation
Specialty: General SurgeryRequired Elements
- Location of lump
- Size and consistency
- Associated symptoms
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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