Oncology & Hematology Coding Alert

Look for both site and side in male breast options.

You won’t find a one-to-one match for coding options in ICD-9 and ICD-10 for malignant neoplasms of the breast. Also, male breast coding options are more elaborate when compared to those for female breast. Here is how you can make your way to the right code in ICD-10.

Determine Laterality for Any Site in Female Breast

For malignant neoplasm in female breast, both ICD-9 and ICD-10 offer site specific options. ICD-10 offers you discrete code choices depending upon whether the pathology lies in the right or left breast. Also, for every quadrant and site of the malignant neoplasm of the breast, you have a specific code which you can report if your physician does not document the laterality in a case of breast cancer. 

Codes for malignant neoplasm of nipple, areola, and central portion of breast: For malignant neoplasm of the nipple and areola of the female breast, you report ICD-9 code 174.0 (Malignant neoplasm of nipple and areola of female breast). This maps to codes C50.011 (Malignant neoplasm of nipple and areola, right female breast) and C50.012 (Malignant neoplasm of nipple and areola, left female breast) in ICD-10. If your physician does not specify whether the right or left breast was involved, you report ICD-10 code C50.019 (Malignant neoplasm of nipple and areola, unspecified female breast). Similarly, for the malignant neoplasm of the central portion of the female breast, you have one ICD-9 code 174.1 (Malignant neoplasm of central portion of female breast) and three ICD-10 codes: C50.111 (Malignant neoplasm of central portion of right female breast), C50.112 (Malignant neoplasm of central portion of left female breast) and C50.119 (Malignant neoplasm of central portion of unspecified female breast).

Check for specific options for each quadrant: When reporting malignant neoplasm located in any one of the four quadrants of the female breast, you again need to confirm if it was the left or the right breast that was affected. Accordingly, you would then choose a specific code as shown in table 1. You also have a specific code to turn to if your physician does not document the side/laterality of the neoplasm.

Pick up right code for axillary tail of the breast: The ICD-9 code for malignant neoplasm of the axillary tail of the female breast is 174.6 (Malignant neoplasm of axillary tail of female breast). Like codes for malignant neoplasms in other areas of the breast, you have specific codes for the right and left sides, i.e., C50.611 (Malignant neoplasm of axillary tail of right female breast) and C50.612 (Malignant neoplasm of axillary tail of left female breast). When the right or left side is not certain, you should report code C50.619 (Malignant neoplasm of axillary tail of unspecified female breast).

You have specific codes for overlap in female breast: When reporting malignant neoplasm of contiguous or overlapping sites of female breast whose point of origin cannot be determined, you have ICD-9 option 174.8 (Malignant neoplasm of other specified sites of female breast). ICD-10 offers you specific choice for reporting neoplasm of overlapping sits. Once again, laterality is your guide in such cases. You can choose from the following: 

• C50.819, Malignant neoplasm of overlapping sites of unspecified female breast
• C50.811, Malignant neoplasm of overlapping sites of right female breast
• C50.812, Malignant neoplasm of overlapping sites of left female breast

Note: You also report ICD-9 code 174.8 for malignant neoplasm of female breast located in ectopic sites, inner breast, lower breast, midline of breast, outer breast, or upper breast. In ICD-10, you will not have any specific options for these locations. So, it is best that you ensure your physician precisely documents which quadrant or site in the breast was involved by the neoplasm. 

Do not lose focus when site isn’t specified: You will come across situations when your physician does not document any specific site for the malignant neoplasm in the female breast. In this case, the ICD-9 option is 174.9 (Malignant neoplasm of breast [female] unspecified site). This code maps to C50.919 (Malignant neoplasm of unspecified site of unspecified female breast), C50.911 (Malignant neoplasm of unspecified site of right female breast), and C50.912 (Malignant neoplasm of unspecified site of left female breast) in ICD-10.

ICD-10: Consider Specific Site in Male Breast Neoplasm

Both ICD-9 and ICD-10 offer options for male breast neoplasm. In addition to laterality, you will gather focus on site of neoplasm for male breast. Unlike ICD-9, ICD-10 lists specific options for each site in male breast.

ICD-9 options: In ICD-9, you have two codes to choose from depending upon the malignant neoplasm is in nipple and areola or other sites of the male breast. The two codes are the following: 

• 175.0, Malignant neoplasm of nipple and areola of male breast
• 175.9, Malignant neoplasm of other and unspecified sites of male breast

ICD-10 options: Like the codes for malignant neoplasm of the female breast, the codes for the malignant neoplasm of the nipple and areola of the male breast depend upon laterality. You select from C50.029 (Malignant neoplasm of nipple and areola, unspecified male breast), C50.021 (Malignant neoplasm of nipple and areola, right male breast), or C50.022 (Malignant neoplasm of nipple and areola, left male breast) for the unspecified, right, and left sides, respectively. 

However, the ICD-9 code 175.9 maps to site-specific options for the malignant neoplasm of male breast in ICD-10. Hence, you look for both site and side for male breast options. These specific ICD-10 codes are listed in table 2. 

Documentation is key: You should ensure your physician documents both the site and side when reporting malignant neoplasm of male breast. In an instance when your physician documents neither the specific site nor the side, you look at ICD-10 option C50.929 (Malignant neoplasm of unspecified site of unspecified male breast).