Pathology/Lab Coding Alert

Update ER/PR status codes, too.

You'll face significant changes in how you report in situ breast cancers once ICD-10 goes into effect -- even if you'll have a little longer to prepare for the switch.

Don't forget: CMS has announced a proposed implementation date delay from Oct. 1, 2013 for the new diagnosis code set. The new implementation date is not yet finalized.

Look for Specific Type, Location in ICD-10

While ICD-9 provides just one code for in situ breast cancer (233.0, Carcinoma in situ of breast), you'll have 12 codes to choose from when ICD-10 goes into effect.

The new code set divides these cancers into four categories by "type": lobular, intraductal, other specified, and unspecified. You'll also need to designate whether the tumor is from the left, right, or unspecified breast.

Here are the ICD-10 crosswalk code choices for 233.0:

• 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

Look for Direct ER Status Crosswalk

Once ICD-10 goes into effect, you'll have a one-to-one code correspondence from ICD-9 for reporting the breast cancer patient's estrogen receptor (ER) status, as follows:

Like ICD-9, ICD-10 does not provide distinct codes to report progesterone receptor status.