Benign neoplasm of breast

This code signifies the presence of a non-cancerous growth or tumor within the breast tissue. These benign neoplasms are typically localized, do not invade surrounding tissues, and do not metastasize to distant sites. They are often discovered incidentally during imaging or physical examination.

Assign this code when documentation confirms a benign neoplasm of the breast, such as a fibroadenoma, intraductal papilloma, or adenosis. This code is appropriate for initial diagnosis, follow-up, or when a biopsy confirms benignity. Supporting documentation includes pathology reports, imaging reports (e.g., mammogram, ultrasound, MRI) indicating a benign finding, or physician notes explicitly stating a benign breast mass.

• Do not use this code if the neoplasm is described as uncertain behavior, in situ, or malignant; use the appropriate codes from categories 236 or 174.
• Specify the laterality (left, right, bilateral) if documented, using a more specific subcategory if available.
• Ensure the pathology report definitively rules out malignancy before assigning this benign code.