Gynecomastia, the enlargement of breast tissue in males, necessitates precise diagnosis and coding for accurate medical billing and record-keeping. Within the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), the designated Diagnosis Code For Gynecomastia and related conditions is N62, Hypertrophy of breast. This article offers a detailed exploration of ICD-10-CM code N62, covering its applications and essential considerations for its use in healthcare settings.
What is ICD-10-CM Code N62?
ICD-10-CM code N62 is recognized as a billable/specific code, indicating its accuracy for diagnostic and reimbursement purposes. This code has been in effect since October 1, 2015, with ongoing updates reflected in the 2025 ICD-10-CM version, which became effective on October 1, 2024. Code N62 is utilized to denote a diagnosis of “Hypertrophy of breast,” specifically applicable to:
- Gynecomastia
- Hypertrophy of breast, Not Otherwise Specified (NOS)
- Massive pubertal hypertrophy of breast
Understanding Gynecomastia
Gynecomastia is defined by the enlargement of breast tissue in males, resulting from a hormonal imbalance, particularly an increase in estrogen levels relative to androgens. It is crucial to distinguish between physiological gynecomastia, which is a normal occurrence in newborns, adolescents, and aging males due to hormonal fluctuations, and pathological gynecomastia, which may stem from underlying medical conditions or medication side effects. Although ICD-10-CM code N62 does not differentiate between these types, understanding the underlying cause of gynecomastia is vital for appropriate diagnosis and management.
ICD-10-CM N62: Key Details
Type 1 Excludes: The ICD-10-CM system employs “Type 1 Excludes” notes to identify codes that should not be used simultaneously with N62. This designation indicates conditions that are mutually exclusive with Hypertrophy of breast. While the original article mentions “Type 1 Excludes” for N62, specific excluded codes are not listed. It’s important for medical coders to consult the full ICD-10-CM documentation for a complete list of Type 1 Excludes related to N62 to ensure coding accuracy.
Annotation Back-References: ICD-10-CM codes frequently include annotations to provide additional context and instructions. “Annotation back-references” for N62 direct users to other codes within the ICD-10-CM system that contain annotations relevant to N62. These annotations encompass categories such as “Applicable To,” “Code Also,” “Code First,” “Excludes1,” “Excludes2,” “Includes,” “Note,” or “Use Additional” notes. These references are designed to facilitate precise and comprehensive coding by guiding coders to related information within the ICD-10-CM framework.
Approximate Synonyms: Several terms are recognized as approximate synonyms for N62, offering alternative ways to describe the condition:
- Atypical lobular hyperplasia
- Atypical lobular hyperplasia of breast (left, right, unspecified)
- Gynecomastia
- Pseudoangiomatous stromal hyperplasia of breast
These synonyms clarify the scope of N62 and aid in selecting the correct code when encountering these terms in medical records and clinical documentation.
Clinical Information: ICD-10-CM N62 is applied to conditions marked by:
- Excessive breast development in males.
- Breast enlargement in males caused by estrogen excess.
- Breast enlargement in males due to hormonal imbalances or certain medications.
- Excessive enlargement of one or both breasts, potentially linked to factors like obesity and specific drug therapies.
DRG Grouping and Code History: ICD-10-CM N62 is categorized within Diagnostic Related Groups (MS-DRG v42.0), which is pertinent to hospital billing and reimbursement processes. Introduced in 2016, code N62 has remained consistent through the 2025 edition, affirming its established and ongoing use within the ICD-10-CM system for coding hypertrophy of the breast, including gynecomastia.
Using N62 for Diagnosis and Billing
The accurate application of ICD-10-CM codes like N62 is crucial for correct medical billing and reimbursement. Employing the appropriate diagnosis code ensures that claims are processed without errors and that patient medical records are an accurate representation of their health status. For gynecomastia and related conditions of breast hypertrophy in males, N62 is the designated and most appropriate code. It is essential to adhere to all ICD-10-CM guidelines and be mindful of “Type 1 Excludes” and other instructional notes to maintain coding accuracy and compliance.
Conclusion
ICD-10-CM code N62, Hypertrophy of breast, serves as the standard diagnosis code for gynecomastia and related conditions within the ICD-10-CM system. A thorough understanding of this code, including its specific applications, associated synonyms, and clinical context, is indispensable for healthcare professionals involved in diagnosis, medical coding, and billing processes. Accurate coding with N62 is not only vital for ensuring appropriate reimbursement but also for contributing to effective and reliable healthcare data management.
