N63.0 ICD-10-CM Code: Unspecified lump in unspecified breast
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the genitourinary system (N00-N99) / Disorders of breast (N60-N65)
N63.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceUnspecified lump in unspecified breast
A palpable lump or mass in the breast that has not been further characterized or identified. This requires further evaluation to determine if it is benign or malignant.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Nodule(s) NOS in breast
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for N63.0 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for N63.0 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for N63.0 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for N63.0 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for N63.0 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for N63.0 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is N63.0 an HCC code?
No. N63.0 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
N63.0 is the ICD-10-CM diagnosis code for unspecified lump in unspecified breast. A palpable lump or mass in the breast that has not been further characterized or identified. This requires further evaluation to determine if it is benign or malignant. N63.0 sits in the ICD-10-CM chapter for diseases of the genitourinary system (n00-n99), within the section covering disorders of breast (n60-n65).
N63.0 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This is a symptom code; use it only when the specific nature of the lump is unknown; once diagnosed, use the appropriate diagnosis code.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for N63.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a symptom code; use it only when the specific nature of the lump is unknown; once diagnosed, use the appropriate diagnosis code
- •Document the location, size, consistency, and any associated symptoms to guide further workup