Oncology & Hematology Coding Alert

Plan ahead for increased category and anatomy requirements.

ICD-10-CM has a long list of codes in store for breast carcinoma in situ. Be sure your documentation can stand up to future requirements to know the type and the affected breast.

ICD-9-CM Code

• 233.0, Carcinoma in situ of breast

ICD-10-CM Codes

• D05.00, Lobular carcinoma in situ of unspecified breast
• D05.01, ... right breast
• D05.02, ... left breast
• D05.10, Intraductal carcinoma in situ of unspecified breast
• D05.11, ... right breast
• D05.12, ... left breast
• D05.80, Other specified type of carcinoma in situ of unspecified breast
• D05.81, ... right breast
• D05.82, ... left breast
• D05.90, Unspecified type of carcinoma in situ of unspecified breast
• D05.91, ... right breast
• D05.92, ... left breast

"Carcinoma in situ" refers to tumor cells undergoing malignant changes but not invading the surrounding tissue.

ICD-9-CM coding rules: ICD-9-CM index entries point you to 233.0 for diagnoses including (noninfiltrating) intraductal papillary adenocarcinoma, intraductal carcinoma in situ, and lobular carcinoma in situ.

ICD-10-CM changes: While ICD-9-CM provides just one code for in situ breast cancer, you'll have a dozen codes to choose from when ICD-10-CM goes into effect. The new code set divides these cancers into four categories: lobular, intraductal, other specified, and unspecified. You'll also need to designate whether the tumor is in the left, right, or unspecified breast.

Documentation: Because the ICD-10-CM codes differ based on whether the carcinoma is lobular, intraductal, other specified, or unspecified, your transition preparation should include making this information easily accessible in the documentation. You'll similarly need to be able to identify the affected breast to choose the most specificcode.

Coder tips: ICD-9-CM and ICD-10-CM have similar excludes notes for this diagnosis. Under ICD-10-CM, the D05 code range has this note:

Excludes1:

• Carcinoma in situ of skin of breast (D04.5)
• Melanoma in situ of breast (skin) (D03.5)
• Paget's disease of breast or nipple (C50.-).

ICD-10-CM guidelines state, "An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note." Also take note that the bullets list diagnoses rather than code definitions. Code D04.5 is defined as "Carcinoma in situ of skin of trunk," but it includes "Carcinoma in situ of skin of breast." The range D03.5- is defined as "Melanoma in situ of trunk." So to report "Melanoma in situ of breast (skin) (soft tissue)," you need to add a fifth digit: D03.52. The range C50.- is defined as "Malignant neoplasm of breast." But a note with the range specifies it applies to Paget's disease of breast or nipple.

Remember: When ICD-10-CM goes into effect, 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. HHS Secretary Kathleen Sebelius issued a press release announcing the proposed delayed implementation date of Oct. 1, 2014. The final rule has not been announced as of the date of this publication.