Understanding Dense Breast Tissue and ICD-10 Coding for Mammograms

Understanding Dense Breast Tissue and ICD-10 Coding

Dense breast tissue is a common finding that shows up on mammograms. It refers to breasts that have a higher proportion of glandular and connective tissue compared to fatty tissue. This increased density can make it more difficult to detect cancer on mammograms. Recently, there has been more awareness around dense breasts and how they relate to cancer screening and risk. This article will provide an in-depth overview of dense breast tissue, including how it is coded in ICD-10.

What is Dense Breast Tissue?

Breasts are made up of glandular, connective, and fatty tissues. Women with dense breasts have more glandular and connective tissues compared to fatty tissue. On a mammogram, dense tissue shows up as solid white areas, while fatty tissue appears dark. Doctors often categorize breast density into 4 categories:

• Almost entirely fatty
• Scattered areas of dense glandular and connective tissue
• Heterogeneously dense
• Extremely dense

Women with heterogeneously or extremely dense breasts make up 40-50% of the female screening population. Increased breast density is a symptomless condition that is usually first detected on screening mammography. It is important to note that breast density refers to the ratio of different tissues in the breast, not the size or firmness. Dense breast tissue is normal and simply refers to the amount of glandular and connective tissue compared to fat.

Risks of Dense Breast Tissue

While increased breast density is common and non-cancerous, it does increase a woman's breast cancer risk. Dense breasts make it more difficult to see cancer on mammograms because the dense tissue appears white on images, similar to tumors. This means cancers can be masked or obscured by dense tissue. Studies show that women with extremely dense breasts have a modestly increased risk of breast cancer compared to women with average breast density.

In addition, dense breast tissue increases the risk that a mammogram will be false-negative, meaning cancer is missed. False-negative results occur more frequently in premenopausal women and those with dense breasts. At the same time, dense tissue increases the risk of false-positive mammogram results, leading to additional testing and biopsies. Overall, high breast density decreases the sensitivity of mammograms and increases the risks of delayed cancer diagnosis.

Recommendations for Women with Dense Breasts

If you receive mammogram results indicating you have dense breast tissue, additional screening may be recommended by your doctor. Common supplemental screening options include:

• 3D mammography or tomosynthesis
• Whole breast ultrasound
• Breast MRI

These tests may be used along with standard 2D digital mammography to improve cancer detection in dense breasts. 3D mammography provides multiple images of the breast from different angles, reducing the tissue overlap that can obscure tumors. Ultrasound uses soundwaves to create images of the breast and can help detect cancers that mammograms may miss. MRI does not use radiation and may find other cancers not seen on mammography.

Your doctor can help decide if additional screening is right based on your individual breast cancer risk factors. They may also recommend breast cancer screening at an earlier age or getting mammograms more frequently than annually. Being aware of your breast density and talking to your doctor can help ensure you get the most appropriate screening.

Dense Breast Notification Laws

Currently, 38 U.S. states have enacted dense breast notification legislation. These laws require healthcare facilities to inform patients if they are found to have dense breast tissue on a mammogram. Patients must also be advised that dense tissue can hide cancers and be given information about supplemental screening options. These laws aim to raise awareness about dense breasts and empower patients to talk to their doctors about personal risk factors.

ICD-10 Coding for Dense Breasts

In ICD-10, dense breast tissue is classified under chapter N - Diseases of the breast. The codes related to breast density provide specific information to healthcare providers about what was found during an exam or breast imaging study. Some common ICD-10 codes for dense breasts include:

R92.2 - Breast density

This general code indicates increased density of breast tissue. It should only be used if no more specific density code applies from the imaging exam.

N63.1 - Unspecified lump in the breast

This code indicates an area of density was found on the mammogram but does not specify a breast quadrant location.

N63.11 - Lump in the right breast

Use this code if increased density is noted in the right breast.

N63.12 - Lump in the left breast

Use this code if increased density is noted in the left breast.

N63.13 - Lump in axillary tail of the breast

Assign this code if increased density is located in the axillary tail region of the breast.

N63.14 - Lump in the breast, subareolar

Use this code if dense tissue is found in the subareolar region of the breast.

N63.15 - Lump in the breast, ectopic

This code indicates increased density located in ectopic breast tissue.

N63.16 - Lump in the breast, inner quadrant

Assign this code when increased density is noted in the inner or medial regions of the breast.

N63.17 - Lump in the breast, lower inner quadrant

Use this code if density is found specifically in the lower inner quadrant of the breast.

N63.18 - Lump in the breast, outer quadrant

Assign this code when increased density is located in the outer or lateral areas of the breast.

N63.19 - Lump in the breast, upper outer quadrant

This code indicates density in the upper outer region of the breast.

Billing and Coding Tips

Here are some important facts to keep in mind when coding for breast density:

• Codes for breast density are based on breast imaging reports like mammography, ultrasound, or MRI.
• Assign as many codes as needed to report all applicable density findings.
• Codes should be routinely updated as new imaging is performed over time.
• Breast density codes do not indicate if additional imaging is needed.
• Codes for screening mammography Z12.- may be assigned along with density codes.
• Use additional codes for any diagnostic mammography or other imaging performed.
• Density codes are informational and do not represent a diagnosis.

Correctly coding breast density provides valuable clinical information and ensures proper reimbursement. Make sure to code density based on the latest imaging findings and update it annually. Being specific about the location of dense areas also aids in clinical correlation between studies. Talk to your healthcare providers if you have any questions on breast density codes recorded in your medical record.

The Bottom Line

Increased breast density is a common finding, affecting up to half of women undergoing screening mammography. Dense tissue is not abnormal but can increase the risk of breast cancer being obscured on imaging. ICD-10 coding for breast density uses specific codes that pinpoint the location and distribution of dense areas in the breasts. Understanding breast density coding provides women and their doctors with important information to guide personalized screening and risk management.

References:

• Breastcancer.org. (n.d.). Dense breasts. Retrieved from https://www.breastcancer.org/risk/factors/breast_density
• American College of Radiology. (n.d.). ACR breast imaging reporting and data system (BI-RADS). Retrieved from https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads
• U.S. Food and Drug Administration. (2019, March 5). FDA updates mammography quality standards. https://www.fda.gov/radiation-emitting-products/mammography-quality-standards-act-and-program/fda-updates-mammography-quality-standards

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.