ICD-10 Coding Breast Mass becomes more specific for coders

The ICD 10 codes are getting more specific with time. I have already shared lot of updates about  diagnosis codes but today we will learn more about them.

Today, we will see the ICD 10 codes added to code for lump or mass in Breast. Earlier, we were using only N63 as the specific code for any part of the breast. But, the  ICD 10 codes changes from 2020 has been expanded for specificity. We now have diagnosis codes for overlapping quadrants to each RT and LT side, just like codes arranged for breast neoplasm.

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ICD 10 codes for Breast Mass N63 

This time we have separate diagnosis code for each quadrant in breast region. From 1st October 2019, coder have started using two ICD 10 codes from N63 category to assign codes for overlapping quadrants. Below are the set of diagnosis codes of N63 category.

N63       Unspecified lump in breast
N63.0    Unspecified lump in unspecified breast 

N63.1    Unspecified lump in the right breast 

N63.10  Unspecified lump in the right breast, unspecified quadrant 
N63.11  Unspecified lump in the right breast, upper outer quadrant 
N63.12  Unspecified lump in the right breast, upper inner quadrant 
N63.13  Unspecified lump in the right breast, lower outer quadrant 
N63.14  Unspecified lump in the right breast, lower inner quadrant 

N63.15 Unspecified lump in the right breast, overlapping quadrants (added in 2020)

N63.2    Unspecified lump in the left breast
N63.20  Unspecified lump in the left breast, unspecified quadrant 
N63.21  Unspecified lump in the left breast, upper outer quadrant 
N63.22  Unspecified lump in the left breast, upper inner quadrant
N63.23  Unspecified lump in the left breast, lower outer quadrant 
N63.24  Unspecified lump in the left breast, lower inner quadrant 

N63.25  Unspecified lump in the left breast, overlapping quadrants (added in 2020)

N63.3    Unspecified lump in axillary tail 
N63.31   Unspecified lump in axillary tail of the right breast 
N63.32  Unspecified lump in axillary tail of the left breast 

N63.4    Unspecified lump in breast, subareolar
N63.41  Unspecified lump in right breast, subareolar 
N63.42  Unspecified lump in left breast, subareolar 

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When to use N63 category ICD codes

The set of ICD 10 codes have to be used mostly with the breast mammogram and breast biopsy procedures. The diagnostic mammogram exam generally use breast lump or mass diagnosis. Also, the breast biopsies which take the breast lump or mass as sample for pathological exam will also use this set of codes. Do use the most specific codes while using these codes. Do check the breast quadrant and the o’clock position of the breast mass or lump, which coding these diagnosis codes (refer the below image for proper coding).

Coding Breast Mass becomes more specific in 2018

<Image credit>

Specific ICD 10 codes for Breast Neoplasm

C50 Malignant neoplasm of breast

               
  •  C50.0 Malignant neoplasm of nipple and areola
  •    C50.01 Malignant neoplasm of nipple and areola, female
    •  C50.011 Malignant neoplasm of nipple and areola, right female breast
    •  C50.012 Malignant neoplasm of nipple and areola, left female breast
    •  C50.019 Malignant neoplasm of nipple and areola, unspecified female breast
    •  C50.02 Malignant neoplasm of nipple and areola, male
      •  C50.021 Malignant neoplasm of nipple and areola, right male breast
      •  C50.022 Malignant neoplasm of nipple and areola, left male breast
      •  C50.029 Malignant neoplasm of nipple and areola, unspecified male breast
  •  C50.1 Malignant neoplasm of central portion of breast
    •  C50.11 Malignant neoplasm of central portion of breast, female
      •  C50.111 Malignant neoplasm of central portion of right female breast
      •  C50.112 Malignant neoplasm of central portion of left female breast
      •  C50.119 Malignant neoplasm of central portion of unspecified female breast
    •  C50.12 Malignant neoplasm of central portion of breast, male
      •  C50.121 Malignant neoplasm of central portion of right male breast
      •  C50.122 Malignant neoplasm of central portion of left male breast
      •  C50.129 Malignant neoplasm of central portion of unspecified male breast
  •  C50.2 Malignant neoplasm of upper-inner quadrant of breast
    •  C50.21 Malignant neoplasm of upper-inner quadrant of breast, female
      •  C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
      •  C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
      •  C50.219 Malignant neoplasm of upper-inner quadrant of unspecified female breast
    •  C50.22 Malignant neoplasm of upper-inner quadrant of breast, male
      •  C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
      •  C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
      •  C50.229 Malignant neoplasm of upper-inner quadrant of unspecified male breast
  •  C50.3 Malignant neoplasm of lower-inner quadrant of breast
    •  C50.31 Malignant neoplasm of lower-inner quadrant of breast, female
      •  C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
      •  C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
      •  C50.319 Malignant neoplasm of lower-inner quadrant of unspecified female breast
    •  C50.32 Malignant neoplasm of lower-inner quadrant of breast, male
      •  C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
      •  C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
      •  C50.329 Malignant neoplasm of lower-inner quadrant of unspecified male breast
  •  C50.4 Malignant neoplasm of upper-outer quadrant of breast
    •  C50.41 Malignant neoplasm of upper-outer quadrant of breast, female
      •  C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
      •  C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
      •  C50.419 Malignant neoplasm of upper-outer quadrant of unspecified female breast
    •  C50.42 Malignant neoplasm of upper-outer quadrant of breast, male
      •  C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
      •  C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
      •  C50.429 Malignant neoplasm of upper-outer quadrant of unspecified male breast
  •  C50.5 Malignant neoplasm of lower-outer quadrant of breast
    •  C50.51 Malignant neoplasm of lower-outer quadrant of breast, female
      •  C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
      •  C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
      •  C50.519 Malignant neoplasm of lower-outer quadrant of unspecified female breast
    •  C50.52 Malignant neoplasm of lower-outer quadrant of breast, male
      •  C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
      •  C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
      •  C50.529 Malignant neoplasm of lower-outer quadrant of unspecified male breast

21 Thoughts to “ICD-10 Coding Breast Mass becomes more specific for coders”

  1. Bhuvana

    I have a query in coding N63. Even for breast mass we are getting documentation at overlapping clock position. Overlapping clock position codes are available only for neoplasm.what about coding overlapping position in breast mass?

    1. thats a very good question..even I am trying to find a answer for this…Once I get clear information on this I will surely post a article on this as well…!!

      1. sonia Moore

        My radiologist have the same question. Do we code it unspecified quadrant?

        1. As per my knowledge their is no specific code for overlapping sites..hence it will be good to use unspecified code for such scenarios

          1. Sheryl Burke

            Medicare does not accept N63.29 unspecified location to support a diagnostic Mammogram.

            1. yes, medicare does not accept unspecified quadrant or site of breast mass diagnosis codes…but when their is no specific clock position for breast mass documented…it is better to code unspecified ICD 10 code for breast mass. We cannot assume and code specific quadrant code for supporting the medical necessity.

  2. […] of breast mass or lump has become more specific in 2018. Similarly, the new specific Z codes for antenatal screening has been added in 2018. Also, […]

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  5. […] Read also: New updated ICD 10 codes for Breast Mass in 2018 […]

  6. Sally

    I have a case where on the US Findings: It stated LT breast mass in the upper outer quadrant were obtained. In 2:00 there is a mass. The Final impression: Mass in the 2:00. My question is; should this mass be go ahead coded to the UOQ? I thought that we aren’t suppose to code when it only state the o’clock but to code when it said the specific quadrant in the final impression. I appreciate the comment. THanks.

    1. Hi sally,
      As per the scenario, we can consider o’clock position and code the specific quadrant ICD 10 code….in this case when it is clearly saying in Final impression the presence of mass at 2 o’clock then it confirms the presence of breast mass in the upper outer quadrant of LT breast. Also, the unspecified quadrant and site of breast mass are failing to fulfill the medical necessity for diagnostic mammogram..hence when it is clearly documented the o’clock position of breast mass…use this information to code the most specific ICD 10 code to fulfill the medical necessity…!!

  7. Becky

    How do you code 12:00, 3:00. 6:00 and 9:00 if that is what the radiologist stated during the interp?

    1. Hi Becky,
      Till now their has been no specific code for these overlapping sites….we are using the unspecified code only for specific LT or RT side of breast….!!hope this will clear your confusion…!!

  8. […] diagnostic mammogram can help to find the nature of abnormal mass or cell present in breast area. The final confirmation about cancerous cells can only be made […]

  9. Stephanie Lagano

    I just had a mammogram and ultrasound done 4 days ago. I have a lump under my left and right armpit. My mammogram code says ICD 10; N63. Can you please tell me what this means. Thank you

    1. For Lump under armpit, you can code R22 series code as well if your payer accept it. Since the exam is breast related, N63 series code is given for supporting the diagnosis code with CPT code ordered. Based of specific clock location of lump on breast we can code the specific N63 ICD 10 code as well.

    2. You can code R22 series ICD10 code as well here but since the cpt code are related to breast exam ( Mammogram) a code from N63 is coded. Since N63 series will support the medical necessity for the ordered CPT code, hence N63 code has been used for this scenario.

  10. […] the surgeon will take a margin or rim of healthy tissue. The intent, of course, is to capture the mass within the breast tissue at the area of concern, but removal of additional structures may be required. If the intent is to […]

  11. Kelly Crown

    So what code is everyone using for Medicare when any “unspecified” codes aren’t working?

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