ICD-10 Coding for Breast Cancer(C50.911, C50.912)
Complete ICD-10-CM coding and documentation guide for Breast Cancer. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Cancer
C50.0-C50.9Primary Range
Malignant neoplasm of breast
This range covers all malignant neoplasms of the breast, including specific quadrants and laterality.
Carcinoma in situ of breast
This range is used for non-invasive breast cancer, important for early-stage diagnosis.
Personal history of malignant neoplasm of breast
Used for patients with a history of breast cancer who are no longer receiving active treatment.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C50.911 | Malignant neoplasm of unspecified site of right female breast | Use when the specific site within the right breast is not documented. |
|
| C50.912 | Malignant neoplasm of unspecified site of left female breast | Use when the specific site within the left breast is not documented. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for carcinoma of breast
Essential facts and insights about Breast Cancer
Primary ICD-10-CM Codes for carcinoma of breast
Decision Criteria
documentation Criteria
- Laterality must be documented
Applicable To
- Breast cancer NOS
- Right breast cancer
Excludes
- Carcinoma in situ of breast (D05.-)
Clinical Validation Requirements
- Biopsy confirming malignancy
- Imaging studies showing tumor location
Code-Specific Risks
- Risk of unspecified site leading to claim denials
Coding Notes
- Ensure laterality is specified to avoid unspecified coding.
C50.912 - Malignant neoplasm of unspecified site of left female breast
Use when the specific site within the left breast is not documented.
Applicable To
- Breast cancer NOS
- Left breast cancer
Excludes
- Carcinoma in situ of breast (D05.-)
Clinical Validation Requirements
- Biopsy confirming malignancy
- Imaging studies showing tumor location
Coding Notes
Ensure laterality is specified to avoid unspecified coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for follow-up examination after completed treatment for malignant neoplasm
Z08Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Breast Cancer to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C50.911.
Impact
Clinical: Impacts treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always include laterality in clinical documentation.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of health records.
Mitigation Strategy
Always use the most specific code available based on documentation.
Impact
High risk of audit for codes without specified laterality.
Mitigation Strategy
Ensure all clinical documentation includes 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 Cancer, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Breast Cancer
Use these documentation templates to ensure complete and accurate documentation for Breast Cancer. These templates include all required elements for proper coding and billing.
Invasive ductal carcinoma, left breast
Specialty: OncologyRequired Elements
- Laterality
- Quadrant
- Histologic type
- Biomarker status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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