Unsp superficial injuries of breast, unsp breast, sequela

This code signifies the long-term effects or complications arising from a superficial injury to an unspecified breast, where the initial injury type was not specified. It indicates that the acute phase of the injury has passed, and the patient is now presenting with residual issues related to that past trauma.

Use this code when documenting a patient presenting for follow-up care or treatment of a condition directly resulting from a previous, unspecified superficial breast injury. This applies when the specific nature of the original superficial injury (e.g., abrasion, contusion) is unknown or not documented, and the laterality of the breast is also not specified.

• Only use this code for sequela (late effects) of a superficial breast injury.
• Avoid using this code if the specific type of superficial injury (e.g., abrasion, contusion) is known and documented.
• Ensure documentation clearly supports the "unspecified" nature of both the injury type and laterality, and that the encounter is for a sequela.