Pathology/Lab Coding Alert

Question: Our pathologists examine lots of breast cases, so we're trying to prepare for diagnosis coding changes when ICD-10 takes effect, especially for malignancies. What differences should we expect?

Virginia Subscriber

Answer: Using ICD-9, your coding options for primary breast neoplasms differ based on sex.

For female patients you use 174.x (Malignant neoplasm of female breast), and your fourth digit options relate to anatomic location:

• 174.0 -- ... nipple and areola
• 174.1 -- ... central portion
• 174.2 -- ... upper-inner quadrant
• 174.3 -- ... lower-inner quadrant
• 174.4 -- ... upper-outer quadrant
• 174.5 -- ... lower-outer quadrant
• 174.6 - ... axillary tail
• 174.8 -- ... other specified sites of female breast
• 174.9 -- ... breast (female), unspecified.

For male patients, you use 175.x (Male neoplasm of male breast). The fourth digit again relates to anatomic site, but the list is much shorter:

• 175.0 -- ...nipple and areola
• 175.9 -- ... other and unspecified sites of male breast.

ICD-9 instructions for both 174.x and 175.x tell you to report an additional code to identify the patient's estrogen receptor status (V86.0, Estrogen receptor positive status [ER+]; V86.1, Estrogen receptor negative status [ER-]).

ICD-10 changes: You'll find a lot of similarities between ICD-9 and ICD-10 coding options for breast neoplasms, such as the terminology used to identify anatomic locations. There are some differences you need to be aware of, though. Here's how ICD-10 structures the primary malignant breast neoplasm range.

• C50.- is the range for "Malignant neoplasm of breast." As with ICD-9, you will use an additional code to identify estrogen receptor status (Z17.0, Estrogen receptor positive status [ER+]; Z17.1, Estrogen receptor negative status [ER-]).
• The fourth character of the C50.- range identifies the anatomic area: nipple and areola, central portion, upper-inner quadrant, etc. One difference between ICD-9-CM and ICD-10-CM is that ICD-9-CM has an "other sites" code for the female breast. ICD-10-CM does not offer an "other sites" code. It does offer a code range for "overlapping sites": C50.8-. The range applies to male and female patients, as explained in the next point.
• The fifth character of the C50.- range allows you to identify whether the patient is male or female. As a result, you'll need to know the precise anatomic location of the neoplasm for both male and female patients. This differs from ICD-9-CM, which has only two code options for male breast cancer patients.
• The sixth character of the C50.- range identifies the affected breast (right, left, or unspecified).

Look at this example of the ICD-10 code options for an upper-outer quadrant neoplasm:

• C50.411 -- Malignant neoplasm of upper-outer quadrant of right female breast
• C50.412 -- ... left female breast
• C50.419 -- ... unspecified female breast
• C50.421 -- ... right male breast
• C50.422 -- ... male breast
• C50.429 -- ... unspecified male breast.