Pathology/Lab Coding Alert

Question: When the pathologist completes a malignant breast cancer case and has performed scoring for ER or PR, what diagnosis code(s) should you use for the case, such as the following:

Diagnosis: invasive ductal carcinoma (upper-outer quadrant) Carcinoma is ER-positive (the pathology report provides an ER immunostain score)

Codify Subscriber

Answer: If the pathologist diagnoses malignant breast cancer and also provides an estrogen receptor (ER) test result that is available at the time of billing, you should report first the cancer findings, and additionally report the ER status.

In the example you gave, you should report 174.4 (Malignant neoplasm of upper-outer quadrant of female breast) followed by V86.0 (Estrogen receptor positive status [ER+]). ICD-9 code 174.4 includes the instruction to “use additional code to identify estrogen receptor status”

You’ll follow the same process for ICD-10 starting on the implementation date of Oct. 1, 2015. Under ICD-10 you would code the same condition as C50.419 (Malignant neoplasm of upper-outer quadrant of unspecified female breast). Note that you can more accurately report this condition if you have information about whether the lesion is in the left or right breast (C50.411, Malignant neoplasm of upper-outer quadrant of right female breast; or C50.412 Malignant neoplasm of upper-outer quadrant of left female breast).

ICD-10 also includes the instruction for C50 category codes that you “use additional code to identify estrogen receptor status.” Under ICD-10, you should report ER status using Z17.0 (Estrogen receptor positive status [ER+]) or Z17.1 (Estrogen receptor negative status [ER-])

Neither ICD-9 nor ICD-10 provide a specific code for PR status.