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  3. Diagnosis Codes in MS-DRG 601 - Non-Malignant Breast Disorders Without CC/MCC

Diagnosis Codes in MS-DRG 601 - Non-Malignant Breast Disorders Without CC/MCC

The Medicare Severity Diagnosis-Related Group (MS-DRG) is a patient classification system used to categorize hospital cases based on clinical similarity and expected resource use. MS-DRGs organize all possible principal diagnoses into mutually exclusive groups known as Major Diagnostic Categories (MDCs), which help determine reimbursement under the Medicare Inpatient Prospective Payment System.

This section lists the diagnosis codes included in MS-DRG V42.0: Non-Malignant Breast Disorders without CC/MCC from October 1, 2024, through September 30, 2025.

MS-DRG: 601

MS-DRG Title: Non-Malignant Breast Disorders without CC/MCC

MCD: 09

Relative Weight: 0.5995 Relative Weight
The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Geometric LOS: 0.60 Geometric Length of Stay
The geometric mean length of stay (GMLOS) is used by Medicare to calculate the reimbursement for patients whose medical treatment takes a much longer or shorter time than average.

Arithmetic LOS: 2.50 Arithmetic Length of Stay
The average length of stay (ALOS) reflects the average number of days a patient spends in a hospital for each admission.

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    • N62 - Hypertrophy of breast

  • D49 - Neoplasms of unspecified behavior

    • D49.3 - Neoplasm of unspecified behavior of breast

  • I97 - Intraoperative and postprocedural complications and disorders of circulatory system, not elsewhere classified

    • I97.2 - Postmastectomy lymphedema syndrome

  • N60.0 - Solitary cyst of breast

    • N60.01 - Solitary cyst of right breast

    • N60.02 - Solitary cyst of left breast

    • N60.09 - Solitary cyst of unspecified breast

  • N60.1 - Diffuse cystic mastopathy

    • N60.11 - Diffuse cystic mastopathy of right breast

    • N60.12 - Diffuse cystic mastopathy of left breast

    • N60.19 - Diffuse cystic mastopathy of unspecified breast

  • N60.2 - Fibroadenosis of breast

    • N60.21 - Fibroadenosis of right breast

    • N60.22 - Fibroadenosis of left breast

    • N60.29 - Fibroadenosis of unspecified breast

  • N60.3 - Fibrosclerosis of breast

    • N60.31 - Fibrosclerosis of right breast

    • N60.32 - Fibrosclerosis of left breast

    • N60.39 - Fibrosclerosis of unspecified breast

  • N60.4 - Mammary duct ectasia

    • N60.41 - Mammary duct ectasia of right breast

    • N60.42 - Mammary duct ectasia of left breast

    • N60.49 - Mammary duct ectasia of unspecified breast

  • N60.8 - Other benign mammary dysplasias

    • N60.81 - Other benign mammary dysplasias of right breast

    • N60.82 - Other benign mammary dysplasias of left breast

    • N60.89 - Other benign mammary dysplasias of unspecified breast

  • N60.9 - Unspecified benign mammary dysplasia

    • N60.91 - Unspecified benign mammary dysplasia of right breast

    • N60.92 - Unspecified benign mammary dysplasia of left breast

    • N60.99 - Unspecified benign mammary dysplasia of unspecified breast

  • N61 - Inflammatory disorders of breast

    • N61.0 - Mastitis without abscess

    • N61.1 - Abscess of the breast and nipple

  • N61.2 - Granulomatous mastitis

    • N61.20 - Granulomatous mastitis, unspecified breast

    • N61.21 - Granulomatous mastitis, right breast

    • N61.22 - Granulomatous mastitis, left breast

    • N61.23 - Granulomatous mastitis, bilateral breast

  • N63 - Unspecified lump in breast

    • N63.0 - Unspecified lump in unspecified breast

  • N63.1 - Unspecified lump in the right breast

    • N63.10 - Unspecified lump in the right breast, unspecified quadrant

    • N63.11 - Unspecified lump in the right breast, upper outer quadrant

    • N63.12 - Unspecified lump in the right breast, upper inner quadrant

    • N63.13 - Unspecified lump in the right breast, lower outer quadrant

    • N63.14 - Unspecified lump in the right breast, lower inner quadrant

    • N63.15 - Unspecified lump in the right breast, overlapping quadrants

  • N63.2 - Unspecified lump in the left breast

    • N63.20 - Unspecified lump in the left breast, unspecified quadrant

    • N63.21 - Unspecified lump in the left breast, upper outer quadrant

    • N63.22 - Unspecified lump in the left breast, upper inner quadrant

    • N63.23 - Unspecified lump in the left breast, lower outer quadrant

    • N63.24 - Unspecified lump in the left breast, lower inner quadrant

    • N63.25 - Unspecified lump in the left breast, overlapping quadrants

  • N63.3 - Unspecified lump in axillary tail

    • N63.31 - Unspecified lump in axillary tail of the right breast

    • N63.32 - Unspecified lump in axillary tail of the left breast

  • N63.4 - Unspecified lump in breast, subareolar

    • N63.41 - Unspecified lump in right breast, subareolar

    • N63.42 - Unspecified lump in left breast, subareolar

  • N64 - Other disorders of breast

    • N64.0 - Fissure and fistula of nipple

    • N64.1 - Fat necrosis of breast

    • N64.2 - Atrophy of breast

    • N64.3 - Galactorrhea not associated with childbirth

    • N64.4 - Mastodynia

    • N64.9 - Disorder of breast, unspecified

  • N64.5 - Other signs and symptoms in breast

    • N64.51 - Induration of breast

    • N64.52 - Nipple discharge

    • N64.53 - Retraction of nipple

    • N64.59 - Other signs and symptoms in breast

  • N64.8 - Other specified disorders of breast

    • N64.81 - Ptosis of breast

    • N64.82 - Hypoplasia of breast

    • N64.89 - Other specified disorders of breast

  • N65 - Deformity and disproportion of reconstructed breast

    • N65.0 - Deformity of reconstructed breast

    • N65.1 - Disproportion of reconstructed breast

  • Q83 - Congenital malformations of breast

    • Q83.0 - Congenital absence of breast with absent nipple

    • Q83.1 - Accessory breast

    • Q83.2 - Absent nipple

    • Q83.3 - Accessory nipple

    • Q83.8 - Other congenital malformations of breast

    • Q83.9 - Congenital malformation of breast, unspecified

  • R92 - Abnormal and inconclusive findings on diagnostic imaging of breast

    • R92.0 - Mammographic microcalcification found on diagnostic imaging of breast

    • R92.1 - Mammographic calcification found on diagnostic imaging of breast

    • R92.2 - Inconclusive mammogram

    • R92.8 - Other abnormal and inconclusive findings on diagnostic imaging of breast

  • R92.3 - Mammographic density found on imaging of breast

    • R92.30 - Dense breasts, unspecified

  • R92.31 - Mammographic fatty tissue density of breast

    • R92.311 - Mammographic fatty tissue density, right breast

    • R92.312 - Mammographic fatty tissue density, left breast

    • R92.313 - Mammographic fatty tissue density, bilateral breasts

  • R92.32 - Mammographic fibroglandular density of breast

    • R92.321 - Mammographic fibroglandular density, right breast

    • R92.322 - Mammographic fibroglandular density, left breast

    • R92.323 - Mammographic fibroglandular density, bilateral breasts

  • R92.33 - Mammographic heterogeneous density of breast

    • R92.331 - Mammographic heterogeneous density, right breast

    • R92.332 - Mammographic heterogeneous density, left breast

    • R92.333 - Mammographic heterogeneous density, bilateral breasts

  • R92.34 - Mammographic extreme density of breast

    • R92.341 - Mammographic extreme density, right breast

    • R92.342 - Mammographic extreme density, left breast

    • R92.343 - Mammographic extreme density, bilateral breasts

  • T85.41 - Breakdown (mechanical) of breast prosthesis and implant

    • T85.41XA - Breakdown (mechanical) of breast prosthesis and implant, initial encounter

  • T85.42 - Displacement of breast prosthesis and implant

    • T85.42XA - Displacement of breast prosthesis and implant, initial encounter

  • T85.43 - Leakage of breast prosthesis and implant

    • T85.43XA - Leakage of breast prosthesis and implant, initial encounter

  • T85.44 - Capsular contracture of breast implant

    • T85.44XA - Capsular contracture of breast implant, initial encounter

  • T85.49 - Other mechanical complication of breast prosthesis and implant

    • T85.49XA - Other mechanical complication of breast prosthesis and implant, initial encounter