2025 ICD-10-CM code N64.5
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the genitourinary system - Disorders of breast Diseases of the genitourinary system Feed
Other signs and symptoms in the breast.
Modifiers may be applicable depending on the specific services provided (e.g., imaging, biopsy). Consult local payer guidelines for modifier requirements.
Medical necessity is established by the presence of concerning breast symptoms warranting further investigation to rule out or diagnose potentially serious conditions, such as breast cancer.The need for diagnostic testing should be documented and justified.
The clinical responsibility involves a thorough history and physical examination, potentially including breast imaging (mammography, ultrasound) and/or biopsy to determine the underlying cause of the symptoms and to rule out or diagnose serious conditions.
In simple words: This code is used when a person has symptoms in their breast that aren't clearly another specific breast problem. This could include things like a lump, pain, discharge from the nipple, or changes in the breast skin.
This code encompasses various non-specific signs and symptoms related to the breast, excluding those explicitly categorized elsewhere (e.g.,fissures, fistulas, fat necrosis, atrophy, galactorrhea, or mastodynia).It may include symptoms such as breast lumps, pain, nipple discharge, skin changes, or other non-specific findings requiring further investigation.
Example 1: A 45-year-old female patient presents with a newly discovered lump in her right breast.Further investigation is needed to determine the nature of the lump (benign or malignant)., A 30-year-old female reports persistent breast pain (mastalgia) without any palpable masses or nipple discharge.The pain is described as cyclical, worsening before menstruation., A 60-year-old female presents with nipple retraction and skin dimpling. Mammography is ordered to evaluate for potential malignancy.
Detailed history of presenting complaint, including symptom onset, duration, character, and any associated factors.Physical examination findings, including breast palpation, and results of any diagnostic imaging (mammography, ultrasound, MRI) or biopsy.
** This code is often used as a placeholder until further investigations determine a more specific diagnosis.Always document the reason for using this code instead of a more specific diagnosis.
- Payment Status: Active
- Specialties:Surgery, Oncology, Radiology, Internal Medicine
- Place of Service:Office, Hospital, Outpatient Clinic