Oncology & Hematology Coding Alert

Question: I have a physician who wants to use "uncertain behavior neoplasm, breast" instead of "lump in breast" prior to testing. When is it appropriate to use uncertain behavior instead of lump?

Codify Member

Answer: You should not use an uncertain behavior code, such as 238.3 (Neoplasm of uncertain behavior of breast), before the oncologist has reviewed the pathology report and confirmed the neoplasm meets certain conditions for uncertain neoplastic characteristics. In the scenario you describe, a code such as 611.72 (Lump or mass in breast) would be more appropriate. (Final code choice will depend on the documentation.)

Uncertain behavior codes are appropriate when the pathologist identifies a neoplasm that exhibits characteristics indicating that it might become malignant. If the tumor has an unpredictable behavior, it then fits in the neoplasm of uncertain behavior category. ICD-9 describes these tumors as "histomorphologically well-defined neoplasms, the subsequent behavior of which cannot be predicted from the present appearance."