ICD Code N64.4

ICD code N64.4 is a classification used to denote mastodynia, which refers to breast pain. This code is utilized in healthcare settings to document and categorize instances where a patient experiences pain in the breast area, which can be due to various causes such as hormonal changes, injury, or other underlying conditions. Proper use of this code is essential for accurate medical billing and ensuring that healthcare providers receive appropriate reimbursement for services related to diagnosing and treating breast pain.

When considering the use of the ICD code for Mastodynia, healthcare providers should evaluate the following diagnostic criteria and symptoms:

1. Breast Pain: Persistent or recurrent pain localized in the breast tissue, which may vary in intensity and duration.

2. Cyclical Nature: Pain that correlates with the menstrual cycle, often intensifying in the luteal phase and subsiding after menstruation.

3. Non-Cyclical Pain: Breast pain that does not follow a menstrual pattern and may be constant or intermittent.

4. Localized Tenderness: Specific areas of tenderness upon palpation of the breast tissue.

5. Absence of Palpable Mass: No detectable lumps or masses in the breast upon physical examination.

6. No Signs of Infection: Lack of symptoms such as redness, warmth, or discharge that would indicate an infectious process.

7. Negative Imaging Results: Imaging studies such as mammograms or ultrasounds that do not reveal any underlying pathology contributing to the pain.

8. Patient History: Consideration of the patient's medical history, including previous episodes of breast pain and any relevant family history.

9. Exclusion of Other Conditions: Ruling out other potential causes of breast pain, such as costochondritis, trauma, or referred pain from other areas.

10. Impact on Daily Activities: Assessment of how the breast pain affects the patient's daily life and activities, including sleep and physical activity.

By systematically evaluating these criteria, healthcare providers can determine the appropriateness of using the ICD code for Mastodynia in their documentation and billing processes.

For the ICD code N64.4 (Mastodynia), the relevant CPT codes that may be applicable for treatment or diagnostic procedures include:

1. 99201-99215 - Evaluation and Management (E/M) codes for office or other outpatient visits, depending on the complexity and time spent with the patient.

2. 76098 - Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral.

3. 77067 - Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed.

4. 76641 - Ultrasound, breast, unilateral, real-time with image documentation, including axilla when performed; complete.

5. 76642 - Ultrasound, breast, unilateral, real-time with image documentation, including axilla when performed; limited.

6. 10021 - Fine needle aspiration biopsy, without imaging guidance; first lesion.

7. 10022 - Fine needle aspiration biopsy, with imaging guidance.

These CPT codes are examples of procedures that may be considered based on the clinical presentation and physician's assessment related to the ICD code N64.4. Always consult the latest CPT code manual and payer policies for the most accurate and applicable coding.

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