General Surgery Coding Alert

Question: We received a pathology report on a breast case that stated, “lobular carcinoma in situ (LCIS) no malignancy found.” According to information I’ve found from the American Cancer Society, LCIS is not considered pre-cancerous because it does not seem to turn to invasive cancer if left untreated. What diagnosis code should I assign for this case?

Super Coder Subscriber

Answer: Regardless of the pathologist’s interpretation, “no malignancy found,” or the American Cancer Society information about the prognosis for LCIS, ICD-9 provides just one code for LCIS: 233.0 (Carcinoma in situ of breast). 

Because the statement in the pathology report seems contradictory, you may want to contact the pathologist to clarify the diagnosis. Other nomenclature exists for similar findings with a clear indication that the specimen shows no malignancy, such as atypical lobular hyperplasia (ALH), which codes to 610.8 (Other specified benign mammary dysplasias). 

ICD-10 to the rescue: The good news is that this sort of ambiguity will not be a problem once ICD-10 goes into effect on Oct. 1, 2015. That’s because ICD-10 does not lump all breast carcinoma in situ diagnoses into one umbrella code. Instead, you’ll have a separate set of codes specifically for LCIS, as follows:

• D05.00 — Lobular carcinoma in situ of unspecified breast
• D05.01 — ... right breast
• D05.02 — ... left breast.

When you have these ICD-10 codes available, the pathologist’s statement regarding the LCIS findings won’t impact your code choice at all.