Radiology Coding Alert

You'll need to know the type and the breast involved.

If you want to see evidence that ICD-10 is often more specific than ICD-9 for the same diagnosis category, compare your coding options for carcinoma in situ of breast.

ICD-9-CM Code

• 233.0, Carcinoma in situ of breast

ICD-10-CM Codes

• D05.00, Lobular carcinoma in situ of unspecified breast
• D05.01, ... right breast
• D05.02, ... left breast
• D05.10, Intraductal carcinoma in situ of unspecified breast
• D05.11, ... right breast
• D05.12, ... left breast
• D05.80, Other specified type of carcinoma in situ of unspecified breast
• D05.81, ... right breast
• D05.82, ... left breast
• D05.90, Unspecified type of carcinoma in situ of unspecified breast
• D05.91, ... right breast
• D05.92, ... left breast

"Carcinoma in situ" refers to tumor cells undergoing malignant changes but not invading the surrounding tissue.

ICD-9-CM coding rules: ICD-9 index entries point you to 233.0 for diagnoses including (noninfiltrating) intraductal papillary adenocarcinoma, intraductal carcinoma in situ, and lobular carcinoma in situ.

ICD-10-CM changes: While ICD-9 provides just one code for in situ breast cancer, you'll have a dozen codes to choose from when ICD-10 goes into effect. The new code set divides these cancers into four categories: lobular, intraductal, other specified, and unspecified. You'll also need to designate whether the tumor is in the left, right, or unspecified breast.

Documentation: Because the ICD-10 codes differ based on whether the carcinoma is lobular, intraductal, other specified, or unspecified, ensure you have quick access to this information in the documentation. You'll similarly need to be able to identify the affected breast to choose the most specific code.

Coder tips: ICD-9 and ICD-10 have similar excludes notes for this diagnosis. Under ICD-10, the D06 code range has this note:

Excludes1:

• Carcinoma in situ of skin of breast (D04.5)
• Melanoma in situ of breast (skin) (D03.5)
• Paget's disease of breast or nipple (C50.-).

ICD-10 guidelines state, "An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note."

Remember: When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update. HHS Secretary, Kathleen Sebelius, issued a press release announcing the proposed delayed implementation date Oct. 1, 2014. The comment period is now closed, and public comments are being reviewed and analyzed. The department is expected to issue the final rule soon.