Is D48.61 a billable ICD-10-CM code?

Yes. D48.61 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does D48.61 sit in the tabular list?

Neoplasms (C00-D49), in the block Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48).

What cannot be coded together with D48.61?

D48.61 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above D48.61 (D48.6, D48) and apply to it just the same.

D48.61

D48.61 — Neoplasm of uncertain behavior of right breast

Billable / specific codeICD-10-CMright

D48.61 is a billable, specific ICD-10-CM code for neoplasm of uncertain behavior of right breast. It is valid for submission on a claim.

Excludes1 inherited from the categories above D48.61

These are not written on D48.61, but they bind it: a note on a category applies to every code beneath it. Billing D48.61 with anything listed here is a denial.

Written on D48.6 — Neoplasm of uncertain behavior of breast

neoplasm of uncertain behavior of skin of breast (D48.5)

Written on D48 — Neoplasm of uncertain behavior of other and unspecified sites

neurofibromatosis (nonmalignant) (Q85.0-)

Risk adjustment

D48.61 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

D48.61 is named in 26 Medicare coverage policies — 26 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
A52849Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
A53101Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® Update
A54188Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID®

Code history

D48.61 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share D48.6. If D48.61 is not quite right, the correct code is usually one of these.

Questions about D48.61

Is D48.61 a billable ICD-10-CM code?: Yes. D48.61 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does D48.61 sit in the tabular list?: Neoplasms (C00-D49), in the block Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48).
What cannot be coded together with D48.61?: D48.61 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above D48.61 (D48.6, D48) and apply to it just the same.