Pathology/Lab Coding Alert

Question: The pathologist diagnosed inflammatory breast cancer. Should we report this using diagnosis code N61 instead of the usual code we use for more common breast cancers, such as IDC or DCIS?

New Mexico Subscriber

Answer: No, you should not list N61 (Inflammatory disorders of breast) for a diagnosis of inflammatory breast cancer. Code N61 provides an “Excludes 1” note for inflammatory carcinoma of breast, referring you instead to C50.9 (Malignant neoplasm of breast of unspecified site).

You should report a code from the C50 (Malignant neoplasm of breast) code family to the fifth character, which is the highest level of specificity. The fourth character identifies the specific breast site such as nipple and areola (0), central portion (1), various quadrants (2 through 5), axillary tail (6), overlapping sites (8), and unspecified site (9). The fifth character indicates female (1) or male (2) breast.

Other malignant breast neoplasms that report to the C50 family include infiltrating (or invasive) ductal carcinoma (IDC) and invasive lobular carcinoma (ILC).

Distinguish in situ: You should not use the C50 family for other breast cancers such as ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS). For these cancers, turn to the D05 family (Carcinoma in situ of breast). LCIS is D05.0- (Lobular carcinoma in situ of breast) and DCIS is D05.1- (Intraductal carcinoma in situ of breast). The fifth characters for both codes indicate unspecified breast (0), right breast (1), or left breast (2).