Breast pain, clinically known as mastodynia, is a common condition that can cause significant discomfort. In medical diagnosis and billing, accurate coding is essential. The ICD-10-CM code N64.4 is specifically designated for mastodynia. This article will explore the details of this diagnosis code, its usage, and related clinical information.
ICD-10-CM Code N64.4: Defining Mastodynia
N64.4 is a billable and specific code within the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) system. This code is used to indicate a diagnosis of mastodynia for medical reimbursement and statistical purposes within the United States. The N64.4 code officially became effective on October 1, 2015, and the latest 2025 edition remains current as of October 1, 2024. It’s important to note that while N64.4 is the U.S. specific version, other international versions of ICD-10 for mastodynia may exist and could differ.
Synonyms and Related Terms for N64.4
To ensure accurate identification and coding, it’s helpful to understand the various terms associated with N64.4. These approximate synonyms provide a broader understanding of what this diagnosis code encompasses:
- Bilateral mastodynia
- Left mastodynia
- Mastodynia (breast pain)
- Mastodynia of bilateral breasts
- Mastodynia of left breast
- Pain of breast
- Right mastodynia
These synonyms highlight that N64.4 covers breast pain in one or both breasts and is the direct code for “mastodynia” or simply “breast pain”.
Clinical Understanding of Mastodynia
Mastodynia, or breast pain, is characterized by discomfort in the breast region. Clinically, breast pain is often categorized into two main types: cyclical and noncyclical.
Cyclical breast pain is typically linked to hormonal fluctuations associated with the menstrual cycle. This type of pain often occurs in both breasts, may fluctuate in intensity throughout the cycle, and tends to subside after menstruation.
Noncyclical breast pain, on the other hand, is not directly related to the menstrual cycle. It can originate from the breast tissue itself or from surrounding areas such as muscles or joints in the chest wall. Noncyclical breast pain can range from mild discomfort to severe, debilitating pain that significantly impacts daily life. The pain can be constant or intermittent and may be localized to a specific area of the breast.
Understanding whether the breast pain is cyclical or noncyclical is crucial for diagnosis and treatment planning. ICD-10-CM code N64.4 encompasses both types of mastodynia, regardless of the underlying cause.
ICD-10-CM Context and Reimbursement
ICD-10-CM codes are integral to the Diagnostic Related Group (DRG) system, which is used for classifying hospital cases and determining reimbursement. N64.4 is grouped within specific DRGs, influencing how healthcare providers are reimbursed for treating patients with mastodynia.
The code history of N64.4 shows it was a new code introduced in 2016 (effective October 1, 2015) and has remained unchanged through the 2025 edition. This stability indicates the established and ongoing recognition of mastodynia as a distinct diagnostic entity.
It’s also important to note the ICD-10-CM codes adjacent to N64.4. These codes, ranging from N63 to N64.9, cover other breast disorders, including unspecified lumps, nipple issues, fat necrosis, atrophy, galactorrhea, and other signs and symptoms in the breast. Understanding the codes surrounding N64.4 provides a broader context of breast-related diagnoses within the ICD-10-CM system.
For claims with a service date on or after October 1, 2015, the use of ICD-10-CM codes, including N64.4 for mastodynia, is mandatory for accurate medical billing and documentation.
In conclusion, ICD-10-CM code N64.4 is the precise diagnosis code for mastodynia or breast pain. It is a billable code used in the U.S. for both cyclical and noncyclical breast pain, playing a crucial role in medical coding, reimbursement, and the statistical tracking of this common condition. Healthcare professionals rely on this code for accurate diagnosis and communication, ensuring appropriate patient care and administrative processes.
