Pathology/Lab Coding Alert

Question: The pathology report indicates that the pathologist examined a breast biopsy from the upper-inner quadrant of the left breast, with a diagnosis of DCIS. How should we code the procedure and the diagnosis in ICD-9 and ICD-10?

Texas Subscriber

Answer: The correct procedure code is 88305 (Level IV - Surgical pathology, gross and microscopic examination…, Breast, biopsy, not requiring microscopic evaluation of surgical margins…).

DCIS, or ductal carcinoma in situ of the breast, reports to 233.0 (Carcinoma in situ of breast) under ICD-9. This is a fairly non-specific diagnosis code that includes lobular carcinoma in situ, intraductal carcinoma in situ, and other specified types of carcinoma in situ, or unspecified carcinoma in situ.

Under ICD-10, you’ll have many more specific codes that distinguish the various types of carcinoma in situ. Also, the ICD-10 codes include specificity for laterality — whether the specimen is from the left breast, right breast, or unspecified breast.

You should report the ICD-10 diagnosis for this case as D05.12 (Intraductal carcinoma in situ of left breast).

Quadrant not relevant: For the carcinoma in situ diagnosis, ICD-10 provides distinct codes for laterality, but not for location of the lesion within the breast. That’s not true for malignant neoplasm breast codes, where the quadrant is critical for accurately reporting a malignant breast neoplasm using category C50 (Malignant neoplasm of breast).