ICD code N62 – Hypertrophy of breast

Key takeaways

ICD-10 Code N62 is a billable ICD-10-CM diagnosis code for hypertrophy of breast, valid for HIPAA-covered transactions from October 1, 2025

N62 covers both female presentations (macromastia, gigantomastia, virginal breast hypertrophy) and male gynecomastia under a single code with no sub-codes

N62 has no laterality sub-codes, so document unilateral versus bilateral involvement in the clinical note rather than in the code

Practice management software like Pabau builds those documentation fields into the consultation form, so the note supports the claim

ICD-10 Code N62: definition and billability

ICD-10 Code N62 is the official ICD-10-CM diagnosis code for Hypertrophy of breast. It is a billable, specific code valid for HIPAA-covered transactions. The 2026 edition of ICD-10-CM N62 became effective on October 1, 2025, and it sits in the code block N60-N65 (Disorders of breast).

N62 is a diagnosis-type code rather than a procedure code. It describes the patient’s condition for reimbursement purposes. Pair it with the appropriate CPT procedure code whenever a surgical or clinical intervention is billed. According to the Centers for Medicare and Medicaid Services (CMS), N62 is valid in the principal or secondary diagnosis position, depending on clinical context.

N62 code at a glance

Synonyms and lay terms for hypertrophy of breast

The ICD-10-CM tabular list includes several approximate synonyms for N62. Knowing them matters for two reasons. A coder searching by clinical term needs to land on the right code, and any of these terms in the chart maps to N62. The CDC/NCHS ICD-10-CM web tool confirms the synonyms below sit in the official index.

• Macromastia: abnormally large breast tissue in females, often causing musculoskeletal symptoms
• Gigantomastia: severe form of macromastia with rapid or extreme breast enlargement
• Virginal breast hypertrophy: also called juvenile or pubertal macromastia; rapid enlargement during puberty
• Gynecomastia: enlarged breast tissue in males, coded under N62 regardless of underlying cause
• Large breast: lay term used by patients; maps to N62 in the ICD-10-CM index
• Breast hypertrophy: direct clinical synonym for hypertrophy of breast

Any of these terms, documented in the clinical note and mapped through the ICD-10-CM alphabetic index, directs the coder to N62. None of the subtypes has a separate code.

Clinical overview: presentations coded under N62

N62 applies across a range of clinical presentations. The common thread is excess breast tissue volume, whether in a female or male patient, and whether congenital, hormonal, or idiopathic in origin.

Female patients: Macromastia presents with breast tissue disproportionate to the patient’s frame. It often produces chronic back and neck pain, skin breakdown in the inframammary fold, difficulty with physical activity, and psychological distress.

Gigantomastia refers to severe, sometimes rapidly progressive enlargement. Virginal breast hypertrophy appears in adolescent females, typically without an identified hormonal driver, and may need early surgical intervention.

Male patients: Gynecomastia involves glandular breast tissue enlargement in males. It is distinct from pseudogynecomastia, which is fat deposition without glandular proliferation. The distinction decides whether N62 is the correct code, because pseudogynecomastia does not map to it.

Functional impairment is the documentation factor that decides insurance coverage. Payers routinely require evidence that the condition causes physical symptoms before approving surgery. Intertrigo, chronic pain, nerve impingement, and restriction of daily activities all qualify.

Nerve symptoms sometimes prompt sensory nerve conduction threshold testing, billed as HCPCS G0255. Medicare does not cover that test anywhere in the country, so plan for a denial and a signed waiver.

N62 documentation requirements

N62 is a single code with no laterality sub-codes and no sub-categories by sex or subtype. That simplicity at the code level puts the documentation burden entirely on the clinical note. Payers assess medical necessity through the chart, because there are no code refinements to assess instead. Building the required fields into the consultation form keeps them from being left to free text.

The following checklist covers what providers must include in the medical record to support N62:

• Clinical indication: the reason the patient presented, including symptoms and duration
• Laterality: unilateral (left or right) or bilateral; this does not change the code, but insurers look for it
• Patient sex: relevant for gynecomastia documentation and for distinguishing other breast disorders
• Subtype, where applicable: gigantomastia, virginal hypertrophy, or gynecomastia if clinically distinguished
• Functional impairment: chronic back pain, shoulder grooving, skin breakdown, rash, or restricted activity
• Surgical intent, if relevant: note whether the visit evaluates a planned reduction mammoplasty or gynecomastia excision
• Conservative treatment history: physiotherapy, weight loss, or supportive garments attempted before surgery was proposed
• Associated symptoms: pain scores, posture changes, or psychological impact where relevant to medical necessity

N62 coding guidelines

The ICD-10-CM Official Guidelines for Coding and Reporting govern how N62 is assigned. Three rules matter most for this code.

Gynecomastia and N62: coding for male patients

The ICD-10 code for gynecomastia is N62. Male patients with gynecomastia use the same code as female patients with macromastia, and there is no sex-specific sub-code. Coders rely on the provider’s documentation to confirm the diagnosis is true gynecomastia rather than pseudogynecomastia. Pseudogynecomastia is not coded under N62. Use the appropriate obesity or lipomatous tissue code instead. The AAPC ICD-10-CM code set lists N62 as the designated code for gynecomastia without further specification.

Macromastia, gigantomastia, and virginal breast hypertrophy

All three subtypes map to N62. Gigantomastia is not assigned a higher severity code, and remains N62 however extreme the presentation. Virginal (juvenile) breast hypertrophy is confirmed as an approximate synonym in the official tabular, so it is also N62. Document the specific subtype in the note for clinical context, but the code does not change.

Laterality in N62

N62 has no laterality sub-codes. Many musculoskeletal and breast disorder codes in ICD-10-CM distinguish left, right, and bilateral, but N62 is a single-code category. The coder cannot capture laterality through the code, so it must sit in the clinical note. Reviewers notice the omission during pre-authorization and audit.

Related ICD-10 codes

N62 sits within the N60-N65 block. Knowing the adjacent codes prevents miscoding and gives you a clear answer when a claim comes back for code clarification.

When a patient with macromastia also has inframammary intertrigo (L30.4), report both codes if both were documented and treated at the encounter. The map below sets out which documented finding takes N62 and which takes another code.

Associated CPT codes for breast hypertrophy

N62 is a diagnosis code, so it pairs with a CPT procedure code whenever an intervention is billed. The pairings below are the common ones in aesthetic and reconstructive practice. Verify payer-specific coverage policy before submission.

A pairing is not a coverage decision. Individual payer policies and local coverage determinations (LCDs) govern reimbursement for each one. For the procedure side of the pairing, see the reference page for CPT 19318. Practice management software like Pabau submits claims electronically and checks eligibility ahead of the procedure date, so coverage problems surface before a denial arrives.

Common coding errors and how to avoid them

These are the errors that produce avoidable denials on N62 claims. Each one has a documentation fix rather than a coding fix. If you are working backwards from a rejection, the published denial codes explain what each one means.

Error 1: Missing functional impairment documentation

Insurers treat reduction mammoplasty as cosmetic unless the chart demonstrates functional impairment. Submitting N62 with CPT 19318 and no documented physical symptoms is the fastest route to a medical necessity denial. Fix: use a documentation template that prompts clinicians to record pain scores, posture findings, skin breakdown, and activity limitations.

Error 2: Coding pseudogynecomastia as N62

Pseudogynecomastia is fat deposition in the male chest without glandular proliferation, and it does not map to N62. Assigning N62 where the provider documented “chest fat” or “lipomatous tissue” creates a documentation-to-code mismatch that auditors flag on review. Fix: confirm the provider explicitly documented glandular breast tissue before assigning N62 for a male patient.

Error 3: Omitting laterality from the clinical record

N62 has no sub-codes for left, right, or bilateral. Coders sometimes assume that because the code does not require laterality, the note does not need it either. Payers conducting medical necessity reviews want to know which side was treated and why. Unilateral gynecomastia raises different clinical questions than bilateral macromastia. Fix: build laterality into every N62 documentation template. Pabau’s software for billing teams keeps the diagnosis documentation attached to the claim it supports.

Error 4: Using N63 instead of N62 for diffuse hypertrophy

N63 (unspecified lump in breast) applies to a discrete, localized mass. Diffuse breast enlargement is N62. When a provider documents “palpable mass” without saying whether the presentation is focal or diffuse, coders sometimes default to N63. Fix: return the note for clarification before assigning the code. The distinction changes both the code and the clinical picture the insurer evaluates.

How Pabau supports accurate N62 documentation

Accurate N62 claims are decided in the clinical note, well before the billing queue sees them. When the documentation is specific, coding is straightforward. When notes are vague, every downstream step gets harder.

Pabau lets plastic surgery and aesthetic medicine practices build N62-specific fields into the consultation template. Laterality, functional impairment scores, conservative treatment history, and surgical intent become structured fields rather than free-text afterthoughts. The note then satisfies payer documentation requirements before the claim is submitted.

Claims then go out electronically with eligibility already verified, so a coverage problem shows up before the patient’s procedure date. That matters most where N62 appears across both cosmetic and reconstructive case mixes.

Reduce coding errors with structured clinical documentation

Pabau’s digital forms and clinical records capture the documentation payers require for N62 claims. Functional impairment, laterality, and surgical intent are recorded as structured fields at the consultation.

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Conclusion

N62 is one code doing the work of several diagnoses, which means the code choice is rarely where a claim goes wrong. What decides payment is whether the chart carries laterality, functional impairment, patient sex, and clinical indication. None of those appear in a sub-code, so none of them are optional in the note.

The practical move is to stop leaving N62 documentation for the coder to chase after the visit. Put the fields in the consultation template and the chase never starts. Book a demo to see how Pabau structures clinical notes for procedure-heavy practices.

Continue your research

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