General Surgery Coding Alert

Male and female breast dx collapse to one family.

You're used to choosing codes from separate ICD-9 families for breast neoplasms depending on patient gender -- but ICD-10 will change all that.

Don't miss: The ICD-10 implementation deadline is shifting from Oct. 1, 2013. Read more about it in "Delay Gives You More Time to Implement ICD-10, HHS Confirms "on page xxx in this issue.

Know ICD-9 Families

You need to know two code families for breast cancer under ICD-9, based on sex.

For female patients you use 174.x (Malignant neoplasm of female breast), and your fourth digit options relate to 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 use 175.x (Male neoplasm of male breast). The fourth digit again relates to anatomic site, but the list is much shorter:

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

ICD-9 instructions 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 is Different

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 will use 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-CM and ICD-10-CM is that ICD-9-CM has an "other sites" code for the female breast. ICD-10-CM does not offer an "other sites" code. It does offer a code range for "overlapping sites": C50.8-. The range applies to male and female patients, as explained in the next point.
• 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-CM, 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).

Look at 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.