Pathology/Lab Coding Alert

Z86.000 beats V13.8 for specificity.

You won’t be lumping ductal carcinoma in situ (DCIS) with all in situ breast cancers once ICD-10 goes into effect Oct. 1, 2014.

Unlike ICD-9, the new code set gives you several specific codes for DCIS, as well as one specific code for history of DCIS. That’s something to keep in mind when your pathologist performs breast tissue exams and possibly immunohistochemistry staining using new/revised CPT^® 2014 codes 88342 and +88343 (Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per block, cytologic preparation, or hematologic smear…).

Expect More Specific Crosswalk

You currently report DCIS as 233.0 (Carcinoma in situ of breast). That’s the same code you’d use for lobular carcinoma in situ or any other specified or unspecified in situ breast cancer.

ICD-9 code 233.0 crosswalks to 12 codes in ICD-10, three specifically for DCIS as follows:

• D05.10 — Intraductal carcinoma in situ of unspecified breast
• D05.11 — Intraductal carcinoma in situ of right breast
• D05.12 — Intraductal carcinoma in situ of left breast.

Notice: This is a great example to counteract the popular belief that you’ll be expected to report a vast number of diagnosis codes on your claims once ICD-10 is implemented. On the contrary, “The ICD-10 codes are more precise. Therefore, one ICD-10-CM code may provide more detailed information than one ICD-9-CM code,” explained CMS’s Pat Brooks in a webinar earlier this year.

Find precise history code, too: If a patient had a previous DCIS lesion, your best bet under ICD-9 is V13.8 (Personal history of other specified diseases). That’s because you shouldn’t report a history of breast cancer — V10.3 (Personal history of malignant neoplasm of breast) — for DCIS, which isn’t a primary malignancy.

But you won’t find an ICD-10 crosswalk for history of DCIS from V13.8 because it’s such a generic code. As with DCIS itself, however, ICD-10 provides a much more specific code for history of DCIS: Z86.000 (Personal history of in-situ neoplasm of breast).