Learn about fibroadenoma of the breast, a common benign breast tumor. This guide covers breast fibroadenoma diagnosis, clinical documentation, and medical coding for healthcare professionals. Find information on ICD-10 codes, treatment options, and patient education resources for fibroadenomas.
Also known as
Fibroadenoma of breast
Benign tumor of breast glandular tissue.
Benign neoplasm of breast
Non-cancerous growths in breast tissue.
Diseases of the breast
Encompasses various breast conditions, including benign and malignant.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the fibroadenoma of the breast confirmed by imaging/biopsy?
Yes
Is it a single fibroadenoma?
No
Do not code. Further investigation needed.
When to use each related code
| Description |
|---|
| Common benign breast tumor, often painless, rubbery. |
| Fluid-filled breast cyst, may be tender or painful. |
| Overgrowth of breast tissue, often lumpy or painful. |
Missing or incorrect laterality (right, left, bilateral) can lead to inaccurate coding and reimbursement issues for fibroadenoma procedures.
Confusing excision and biopsy coding for fibroadenoma can result in claim denials due to mismatched procedures and diagnoses.
Lack of documentation of fibroadenoma size may affect accurate code assignment and impact statistical reporting.
Q: How can I differentiate a fibroadenoma of the breast from other breast masses during a clinical breast exam and what imaging modalities should be considered for definitive diagnosis?
A: Differentiating a fibroadenoma from other breast masses clinically can be challenging as many benign and malignant conditions can present with similar palpable findings. Fibroadenomas typically present as firm, rubbery, mobile, non-tender, well-circumscribed nodules. However, other conditions like cysts, hamartomas, and even some malignant tumors can share these characteristics. Therefore, relying solely on clinical breast exam is insufficient for definitive diagnosis. Imaging studies are crucial. Ultrasound is often the first-line imaging modality and can help characterize the lesion as solid or cystic. Mammography may also be utilized, especially in older patients, but can be less sensitive in detecting fibroadenomas in dense breast tissue. If uncertainty remains after ultrasound and/or mammography, further evaluation with core needle biopsy or fine-needle aspiration cytology should be considered to obtain a tissue diagnosis and rule out malignancy. Explore how a combined approach using clinical exam, imaging, and biopsy can improve diagnostic accuracy.
Q: What are the current best practice guidelines for the management of fibroadenoma of the breast in asymptomatic patients, including follow-up recommendations and criteria for surgical excision?
A: Current best practice guidelines for managing asymptomatic fibroadenomas often favor a conservative approach with close monitoring. For small, stable fibroadenomas confirmed through imaging and/or biopsy, short-term follow-up with clinical breast exam and targeted ultrasound every 6-12 months may be appropriate. Continued stability over time can often reassure both the clinician and the patient. Surgical excision is typically reserved for cases where the fibroadenoma is large, rapidly growing, causing symptoms, or if there is diagnostic uncertainty despite imaging and biopsy. Consider implementing a risk-stratified approach to management, considering patient age, family history, and patient preference in decision-making. The decision for surgical intervention should always be individualized based on the specific clinical scenario. Learn more about the role of vacuum-assisted biopsy as an alternative to surgical excision in select cases.
Patient presents with a palpable breast lump, prompting evaluation for fibroadenoma of the breast. The patient reports finding a discrete, mobile, non-tender mass in the [right/left] breast, consistent with the clinical presentation of a breast fibroadenoma. She denies any nipple discharge, skin changes, or associated lymphadenopathy. Family history is negative for breast cancer. On physical examination, a firm, rubbery, well-circumscribed, mobile nodule approximately [size] cm is palpated in the [upper outer/upper inner/lower outer/lower inner/central] quadrant of the [right/left] breast. No overlying skin changes or axillary lymphadenopathy are noted. Differential diagnosis includes breast cyst, fibrocystic breast changes, and other benign breast tumors. Ultrasound of the breast was performed and revealed a solid, well-defined, oval-shaped mass with smooth margins, suggestive of fibroadenoma. Mammography, if performed, may demonstrate a well-circumscribed, homogeneous density. Biopsy, either fine-needle aspiration (FNA) or core needle biopsy, may be considered for definitive diagnosis and to rule out malignancy, particularly if imaging findings are inconclusive. Management options for breast fibroadenoma include watchful waiting with clinical follow-up, including repeat breast examination and imaging, or surgical excision if the patient experiences symptoms, the mass grows rapidly, or there are concerning imaging features. The patient was counseled on the benign nature of fibroadenomas, breast self-examination techniques, and the importance of regular breast screenings. The patient's diagnosis, treatment plan, and potential complications were thoroughly discussed, and she demonstrated understanding. Follow-up appointment scheduled in [timeframe] for reassessment. ICD-10 code D24.0, Benign neoplasm of breast, and CPT codes for the appropriate evaluation and management services, ultrasound (76641 or 76642), mammogram (77055 or 77056 if performed), and biopsy (19100 or 19101 if performed) will be used for billing and coding purposes.