Radiology Question for the Week of November 14, 2022

Question:

How do you code for a 3, 6, 9, and 12 o’clock breast mass/lesion since there are no “other specified site” or “unspecified quadrant” codes? ICD-10-CM code N63 (Unspecified breast lump) requires specification of the quadrant of the lump site. The radiology report states, “12 o’clock right breast mass.”

Answer:

A. Since there is no ideal method for defining the quadrant of breast lumps at the 3, 6, 9, and 12 o’clock positions, the American College of Radiology (ACR) recommends that radiologists select the nearest quadrant to the abnormality while being as consistent as possible in their practice. For Medicare patients, however, CMS has provided guidance for coding overlapping quadrants in its NCD for Mammograms. The NCD states, “Dual dx codes depicting specific quadrants can be reported instead of unspecified quadrants if found more appropriate by provider.” Given this guidance, a 12 o’clock right breast mass can be reported as ICD-10 code N63.15, (Unspecified lump in right breast, overlapping quadrants), or as dual ICD-10 codes for overlapping quadrants, N63.11 (Unspecified lump in the right breast, upper outer quadrant), and N63.12 (Unspecified lump in the right breast, upper inner quadrant).