Code N63, Unspecified lump in the breast, has been expanded with new codes to provide additional specificity regarding laterality (right, left, unspecified), as well as the quadrant (upper outer, upper inner, lower outer, lower inner, and unspecified). New codes have also been created for unspecified lump in the axillary tail and subareolar areas of the right and left breasts.
When coding the diagnosis of breast conditions and the physician documents the location in terms such as positions on a clock, is it appropriate to code to the associated breast quadrant? For example, based on the statement “lump in the right breast at 11 o’clock,” is it appropriate to assign code N63.11, Unspecified lump in the right breast, upper-outer quadrant of right female breast, if the physician has documented 11 o’clock in lieu of upper-outer quadrant?
Facilities may choose to develop a facility-specific coding guideline addressing the correlation of clock positions and breast quadrants, which would allow code selection to be based on documentation of clock position rather than requiring the provider to document the quadrant.
These facility guidelines must not conflict with the ICD-10-CM Official Guidelines for Coding and Reporting developed by the Cooperating Parties. Additionally, they should not be developed to replace physician documentation needed to support code assignment.