Anesthesia Coding Alert

Male and female breast diagnoses will be combined into one family.

You currently have a fairly detailed list of diagnosis choices for breast neoplasm surgery, with separate code families based on whether the patient is male or female. Big changes will go into effect under ICD-10, however, so here's what you need to know before reporting your anesthesia provider's involvement.

ICD-9 Choices Focus on Gender

Under ICD-9, you choose between two code families for breast cancer, based on the patient's sex.

For female patients you use 174.x (Malignant neoplasm of female breast), with your fourth digit options describing the anatomic location:

• 174.0 -- ... nipple and areola
• 174.1 -- ... central portion
• 174.2 -- ... upper-inner quadrant
• 174.3 -- ... lower-inner quadrant
• 174.4 -- ... upper-outer quadrant
• 174.5 -- ... lower-outer quadrant
• 174.6 -- ... axillary tail
• 174.8 -- ... other specified sites of female breast
• 174.9 -- ... breast (female), unspecified.

For male patients, you turn to code 175.x (Male neoplasm of male breast). The fourth digit again relates to anatomic site, but you only have two options:

• 175.0 -- ...nipple and areola
• 175.9 -- ... other and unspecified sites of male breast.

ICD-9 guidelines for both 174.x and 175.x tell you to report an additional code to identify the patient's estrogen receptor status (V86.0, Estrogen receptor positive status [ER+]; V86.1, Estrogen receptor negative status [ER-]).

ICD-10 Combines Choices in Single Family

You'll find a lot of similarities between ICD-9 and ICD-10 coding options for breast neoplasms, such as the terminology used to identify anatomic locations. There are some differences you need to be aware of, though. Here's how ICD-10 structures the primary malignant breast neoplasm range:

C50.- is the range for "Malignant neoplasm of breast." As with ICD-9, you'll include an additional code to identify estrogen receptor status (Z17.0, Estrogen receptor positive status [ER+]; Z17.1, Estrogen receptor negative status [ER-]).

The fourth character of the C50.- range identifies the anatomic area: nipple and areola, central portion, upper-inner quadrant, etc. One difference between ICD-9 and ICD-10 is that ICD-9-CM has an "other sites" code for the female breast, but ICD-10 does not. It does offer a code range for "overlapping sites," however, that applies to both male and female patients: C50.8-.

The fifth character of the C50.- range allows you to identify whether the patient is male or female. As a result, you'll need to know the precise anatomic location of the neoplasm for both male and female patients. This differs from ICD-9, which has only two code options for male breast cancer patients.

The sixth character of the C50.- range identifies the affected breast (right, left, or unspecified).

Example: See how all the pieces come together in this example of the ICD-10 code options for an upper-outer quadrant neoplasm:

• C50.411 -- Malignant neoplasm of upper-outer quadrant of right female breast
• C50.412 -- ... left female breast
• C50.419 -- ... unspecified female breast
• C50.421 -- ... right male breast
• C50.422 -- ...left male breast
• C50.429 -- ... unspecified male breast.