Oncology & Hematology Coding Alert

Question: Is there guidance around what constitutes as the central portion of the breast? I can’t find specific guidelines as to how far outside the nipple and areola this central portion extends.

AAPC Forum Participant

Answer: While the actual definition of the central portion of the breast should be left up to your oncologist, one source that might be of use in helping identify the area for precise ICD-10-CM coding is Appendix C of the Surveillance, Epidemiology, and End Results (SEER) Coding and Staging manual prepared by the National Cancer Institutes (seer.cancer.gov/tools/ codingmanuals/).

In the breast site-specific module, you’ll find a link labeled Solid Tumor Rules: Breast, which will take you to a document called Breast Equivalent Terms and Definitions (seer.cancer. gov/tools/solidtumor/Breast_STM.pdf). There, you will find a definition of the central portion of breast as the “area extending 1 cm around areolar complex,” along with other descriptive language such as “infra-areolar,” “retroareolar,” “subareolar” and location terms such as behind, below, beneath, under, and underneath the nipple.

Consequently, if your provider notes any of the above, you can use codes from such groups as C50.1- (Malignant neoplasm of central portion of breast).