Oncology & Hematology Coding Alert

Prepare for more specific codes for male breast cancer patients.

ICD-9-CM codes for breast neoplasms are fairly specific, but your ICD-10-CM options kick the detail requirements up another notch. Here's the lowdown on how ICD-10-CM incorporates additional anatomic information and increases the data needed when you code for male patients.

ICD-9-CM coding rules: Using ICD-9-CM 2011, your coding options for primary breast neoplasms differ 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-CM 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-CM changes: You'll find a lot of similarities between your ICD-9-CM and ICD-10-CM 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-CM structures the primary malignant breast neoplasm range.

1. C50.- is the range for "Malignant neoplasm of breast." As with ICD-9-CM, 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-]).

2. 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 point 3.

3. 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.

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

Below is an example of the ICD-10-CM code options for an upper-outer quadrant neoplasm:

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

Coder tips: All of the information you'll need to choose the most specific ICD-10-CM code already may be in the patient's chart. The physician may not be pulling the specific site information into his own documentation in the progress note, however. When you're billing the professional fee, the provider's documentation should support your code choice. So as part of your ICD-10-CM transition plan, educate your providers to routinely document the laterality (right or left) and anatomic location to support appropriate code choice.

Remember: When ICD-10-CM goes into effect on Oct. 1, 2013, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.