ICD 10 Coding Guidelines for Breast Mass-A Practical Approach for Efficient and Accurate Coding.

Learn about the ICD 10 Coding Guidelines for Breast Mass and how they can help healthcare providers accurately diagnose and treat patients.

Breast lumps or masses can be benign or malignant. To ensure accurate coding, it is important to have a basic understanding of breast anatomy, including the quadrants and clock positions. In this article, we will discuss the Quadrants of the breast and coding guidelines for breast lump or mass, or malignant neoplasms of the breast based on breast quadrants and clock position.

Quadrants of the breast (ICD 10 Coding Guidelines for Breast Mass)

The breast is divided into four quadrants

  • Upper outer (superolateral) quadrant
  • Upper inner (superomedial) quadrant
  • Lower outer (Inferolateral) quadrant
  • Lower inner (inferomedial) quadrant

How to Capture Breast Lesion Locations

ICD 10 Coding Guidelines for Breast Mass:- ICD-10-CM groups the diagnosis codes for breast lesions based on the “quadrant” of the breast where the lesions are found. Physicians must report a breast lesion’s location to the highest degree of specificity.

The ICD 10 code should be assigned accurately based on Breast Quadrant & Clock Position when a physician documents the location of a breast lesion using the location on a clock. sometimes physicians describe in the report location of a breast lump, mass, or tumor using a clock position.

Right BreastClock positionLeft breast
Overlapping quadrant12 o’clockOverlapping quadrant
Upper Inner Quadrant1 o’clockUpper Outer Quadrant
Upper Inner Quadrant2 o’clockUpper Outer Quadrant
Overlapping quadrant3 o’clockOverlapping quadrant
Lower Inner Quadrant4 o’clockLower Outer Quadrant
Lower Inner Quadrant5 o’clockLower Outer Quadrant
Overlapping quadrant6 o’clockOverlapping quadrant
Lower Outer Quadrant7 o’clockLower Inner Quadrant
Lower Outer Quadrant8 o’clockLower Inner Quadrant
Overlapping quadrant9 o’clockOverlapping quadrant
Upper Outer Quadrant10 o’clockUpper Inner Quadrant
Upper Outer Quadrant11 o’clockUpper Inner Quadrant

In ICD-10 CM, the following codes are correlated:

C50 Malignant Neoplasm of Breast

code Description
The central portion of the breast
C50.2xUpper Inner Quadrant
C50.3xLower Inner Quadrant
C50.4xUpper Outer Quadrant
C50.5xLower Outer Quadrant
C50.8xOverlapping Quadrant

N63.1 Unspecified lump in the right breast

code Description
N63.10Unspecified Quadrant
N63.11Upper Outer Quadrant
N63.12Upper Inner Quadrant
N63.13Lower Outer Quadrant
N63.14Lower Inner Quadrant
N63.15Overlapping Quadrants

N63.2 Unspecified lump in the left breast

N63.20Unspecified Quadrant
N63.21Upper Outer Quadrant
N63.22Upper Inner Quadrant
N63.23Lower Outer Quadrant
N63.24Lower Inner Quadrant
N63.25Overlapping Quadrant

Examples for assigning ICD 10 code based on Breast Quadrant & Clock Position

1] The physician or healthcare provider may document the location as a lump in the right breast at the 2 o’clock position. Can you suggest the correct code for a lump located at the 2 o’clock position in the right breast? 

Answer – N63. 12 for Unspecified lump in the right breast, upper inner quadrant at 2 o’clock position.

2] physician documented a Malignant neoplasm in the Left breast at the 2 o’clock position. Can you suggest the correct code for malignant neoplasm in the Left breast at the 2 o’clock position?

Answer– C50. 412 for Malignant neoplasm of upper-outer quadrant of left female breast 

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