General Surgery Coding Alert

Other specified sites” won’t be a choice for reporting breast cancer lesions once ICD-10 goes into effect on Oct. 1, 2015.

 

In fact, you can expect 174.8 (Malignant neoplasm of other specified sites of female breast) to crosswalk to the following three codes under ICD-10:

Observe right/left: The most obvious change you’ll notice is that ICD-10 uses a sixth digit of 9, 1, or 2 to distinguish whether the tumor comes from the right or left breast, or if the surgical note doesn’t specify which breast. 

 

‘Overlapping’ Replaces ‘Other’

 

Also notice that the 174.8 code definition describes “other specified sites,” while the C50.8_ codes describe “overlapping sites.”

 

Because ICD-9 includes the following description under 174.8, “Malignant neoplasm of contiguous or overlapping sites of breast whose point of origin cannot be determined,” you can see that both code sets direct you to the fourth digit “8” for overlapping sites. 

 

Inner etc.: Breast code descriptors divide the breast into quadrants, such as “upper inner” or “lower outer.” If the surgical note includes a vague descriptor such as “lower” or “outer,” ICD-9 lists those choices under “other specified sites.” But since ICD-10 does not include a code for “other specified sites,” you should use the “unspecified” code if the op report does not specifically identify the lesion location using the quadrant system or other specific sites, such as areola.

 

Exception: The 174.8 code descriptor includes “ectopic sites,” but ICD-10 states that “Malignant neoplasms of ectopic tissue are to be coded to the site mentioned, e.g., ectopic pancreatic malignant neoplasms are coded to pancreas, unspecified (C25.9).”

 

Male included: Another distinction you’ll find in ICD-10 is that the codes for male breast cancer are gathered into the same C50 family, whereas ICD-9 has a separate code family (175) for male breast cancer.

 

Example: For a male breast cancer of nipple, report 175.0 (Malignant neoplasm of nipple and areola of male breast) using ICD-9, and C50.02- (Malignant neoplasm of nipple and areola, male) using ICD-10.