ICD-10 Coding for Mastalgia(N64.4)
Complete ICD-10-CM coding and documentation guide for Mastalgia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Mastalgia
N60-N64Primary Range
Disorders of breast
This range includes codes for various breast disorders, with N64.4 specifically for mastalgia.
Key Information: ICD-10 code for mastalgia
Essential facts and insights about Mastalgia
Primary ICD-10-CM Code for mastalgia
Decision Criteria
clinical Criteria
- Presence of breast pain without underlying malignancy
documentation Criteria
- Detailed documentation of pain pattern and relation to menstrual cycle
Clinical Validation Requirements
- Documentation of pain pattern (cyclical or non-cyclical)
- Relation to menstrual cycle if cyclical
- Imaging results if applicable
Code-Specific Risks
- Risk of using unspecified codes like N64.9
- Failure to document pain pattern and duration
Coding Notes
- Ensure documentation includes pain pattern, severity, and any imaging findings.
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 Mastalgia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N64.4.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Use structured templates for documentation., Train staff on documentation requirements.
Impact
Reimbursement: May lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding specificity requirements., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Always use N64.4 for documented mastalgia.
Impact
Using 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 Mastalgia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Mastalgia
Use these documentation templates to ensure complete and accurate documentation for Mastalgia. These templates include all required elements for proper coding and billing.
Primary Care Visit for Cyclical Mastalgia
Specialty: Primary CareRequired Elements
- Patient history
- Pain pattern
- Relation to menstrual cycle
- Imaging results
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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