ICD-10 Coding for Breast Carcinoma(C50.411)
Complete ICD-10-CM coding and documentation guide for Breast Carcinoma. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Carcinoma
C50Primary Range
Malignant neoplasm of breast
This range includes all primary malignant neoplasms of the breast, specifying site and laterality.
Carcinoma in situ of breast
This range is used for non-invasive breast cancer, important for differential diagnosis.
Estrogen receptor status
Used to indicate hormone receptor status, which influences treatment decisions.
Key Information: ICD-10 code for breast carcinoma
Essential facts and insights about Breast Carcinoma
Primary ICD-10-CM Code for breast carcinoma
Decision Criteria
clinical Criteria
- Histological confirmation of invasive ductal or lobular carcinoma
documentation Criteria
- Detailed documentation of tumor location using quadrant and clock-face position
Applicable To
- Invasive ductal carcinoma
- Invasive lobular carcinoma
Excludes
- Carcinoma in situ of breast (D05.-)
Clinical Validation Requirements
- Histological confirmation of invasive carcinoma
- Documentation of tumor location and laterality
Code-Specific Risks
- Incorrect laterality documentation
- Omitting specific quadrant information
Coding Notes
- Ensure precise documentation of tumor location and laterality to avoid coding errors.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Estrogen receptor positive status
Z17.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Breast Carcinoma to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C50.411.
Impact
Clinical: May lead to incorrect treatment planning., Regulatory: Non-compliance with ICD-10 coding standards., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Always include laterality in clinical documentation., Review pathology and imaging reports for completeness.
Impact
Reimbursement: Incorrect coding may lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines can result in audit issues., Data Quality: Inaccurate data affects clinical decision-making and research.
Mitigation Strategy
Use C50.812 for overlapping sites instead of multiple specific site codes.
Impact
Audits may focus on the specificity of tumor location documentation.
Mitigation Strategy
Ensure all clinical documentation includes detailed tumor location and laterality.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Breast Carcinoma, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Breast Carcinoma
Use these documentation templates to ensure complete and accurate documentation for Breast Carcinoma. These templates include all required elements for proper coding and billing.
Breast Cancer Diagnosis
Specialty: OncologyRequired Elements
- Tumor location and size
- Histological type
- Receptor status
- Staging information
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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