N64.0

N64.0: Fissure and fistula of nipple

Billable / specific codeICD-10-CM

N64.0 is a billable, specific ICD-10-CM code for fissure and fistula of nipple. It is valid for submission on a claim.

Check N64.0 with the rest of the claim: free scrubber

Excludes2 inherited from the categories above N64.0

Not part of this code, but both may be coded when both are present.

Written on N64: Other disorders of breast

mechanical complication of breast prosthesis and implant (T85.4-)

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

N64.0 is named in 2 Medicare coverage policies: 2 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52849Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
A56448Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography

Alphabetic index entries that lead here

Cracked nipple
Fissure, fissured›nipple
Fistula›nipple

Code history

Unchanged in every release from FY2024 to FY2027.