Pathology/Lab Coding Alert

Hone your skills with the following solutions.

After you’ve answered the preceding quiz questions, compare your thoughts with the following expert responses.

Solution 1: The key to correctly coding this scenario is knowing whether the patient has two distinct lesions, or if the cancer is overlapping the two biopsy sites. If the pathology report is not clear, you would do well to query your pathologist. The pathologist will rely on whether the surgeon submits the lesions together in one container without distinction, or as two separately identified specimens. The distinction is important for both procedure and diagnosis coding.

Here’s why: The general guidelines accompanying ICD-10-CM Chapter 2 tell you that, “for multiple neoplasms of the same site that are not contiguous such as tumors in different quadrants of the same breast, codes for each site should be assigned.” Based on that instruction, you would report two distinctly identified specimens in this case as C50.212 (Malignant neoplasm of upper-inner quadrant of left female breast) and C50.412 (Malignant neoplasm of upper-outer quadrant of left female breast).

However, if the pathologist receives and diagnoses the case as a single specimen overlapping two quadrants, the coding is different. The same ICD-10-CM guideline states, “a primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 (‘overlapping lesion’), unless the combination is specifically indexed elsewhere.” That means if the op report documents that the lesion is overlapping the upper inner and upper outer quadrant, the pathology report should reflect that, and you would report just one code for this case: C50.812 (Malignant neoplasm of overlapping sites of left female breast).

Solution 2: To begin narrowing down the correct code in this situation, you should first go to the ICD-10-CM Alphabetic Index and look up Carcinoma – infiltrating – duct. The index instructs you go to Neoplasm, malignant, by site, which leads you to C50.0- (Malignant neoplasm of nipple and areola).

This parent code more accurately describes the patient’s condition than codes in the similar-sounding D05.1- (Intraductal carcinoma in situ of breast) subcategory. That’s because intraductal carcinoma in situ, also known as ductal carcinoma in situ (DCIS), is a different form of cancer. While it is also malignant, it does not spread to surrounding tissue as intraductal carcinoma (IDC) does, and so DCIS reports to a different ICD-10-CM category.

Details: You need to consider two more important factors before you land on the correct code.

First, you need to make sure you choose the correct 5th character for C50.0-. The code group is subdivided into male and female codes using 5th character 1 for females and 2 for males. Then, a 6th character specifies right (1) and left (2) breasts. Using that information, you should assign C50.021 (Malignant neoplasm of nipple and areola, right male breast) as the correct answer to the question.

Solution 3: Correct coding for this condition depends on your clinical understanding of lipomas. Knowing that these lumps are benign growths of fatty tissue means that you would be correct in bypassing the malignant neoplasm codes immediately. But that doesn’t mean D24.1 (Benign neoplasm of right breast) would be the correct code to use in this situation.

That’s because lipomas, which are not anatomically specific to the breast and can occur almost anywhere in the body, have their own ICD-10-CM category: D17.- (Benign lipomatous neoplasm). These codes are further broken down by anatomical location, making D17.1 (Benign lipomatous neoplasm of skin and subcutaneous tissue of trunk) the correct answer to this question.

Solution 4: When you turn to “papilloma” in the ICD-10-CM index, you’re referred to “Neoplasm, benign, by site.” That should lead you to select D24.2 (Benign neoplasm of left breast).

Don’t miss: ICD-10-CM guideline I.C.21.c.4, tells you that you can assign a family history code when the patient’s family member(s) had a certain disease, such as breast cancer, which causes the patient to be at greater risk of contracting the disease as well. The section continues to direct you to assign the appropriate personal and family history codes as additional diagnoses following the reason for the encounter.

“In this case, you’ll [also] assign Z80.3 [Family history of malignant neoplasm of breast],” says Jennifer M. Connell, BA, CPPM, CPCO, CDEO, CPMA, CPB, CRC, COC, CPC, CPC-P, CPC-I, CCC, CCVTC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CUC, ROCC, CEMA, CMCS, CMRS, AAPC-Approved Instructor, revenue cycle director of Citizens Medical Professionals in Victoria, Texas.