2025 ICD-10-CM code N64.8
(Active) Effective Date: N/A Diseases of the genitourinary system - Disorders of breast XIV Diseases of the genitourinary system Feed
Other specified disorders of breast.
Medical necessity is established based on the specific disorder and its potential impact on the patient's health and well-being.Justification for diagnostic tests, treatments, or referrals should be clearly documented.
Diagnosis and management of this condition falls under the purview of healthcare providers specializing in women's health, such as gynecologists, obstetricians, or primary care physicians.For complex or persistent cases, a referral to a breast specialist or surgeon might be warranted.
In simple words: This code refers to other specific breast disorders that don't fit into other categories, such as a milk-filled cyst or when breasts don't shrink back to their normal size after breastfeeding.
Other specified disorders of breast. This includes conditions like galactocele (a milk-filled cyst) and subinvolution of the breast (incomplete return to normal size after lactation).
Example 1: A 35-year-old woman who recently stopped breastfeeding presents with a persistent lump filled with milk. This is diagnosed as a galactocele and coded as N64.8., A 40-year-old woman, six months postpartum, experiences incomplete breast involution, where her breasts remain larger than their pre-pregnancy size. This is coded as N64.8., A 45-year-old woman presents with a non-inflammatory, non-mass lesion that is determined to be a mammary duct ectasia (dilation or widening of the milk ducts). Since this condition isn't classified elsewhere, it is appropriately coded as N64.8.
Documentation should include a detailed clinical description of the breast disorder, relevant imaging reports (mammograms, ultrasounds), biopsy results (if performed), and treatment plans.Patient history related to breastfeeding, hormonal changes, and any relevant family history of breast conditions should also be noted.
- Specialties:Gynecology, Obstetrics, Primary Care, Breast Surgery
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital (if complications require admission)