General Surgery Coding Alert

Question: The surgeon removed a breast mass from a 42-year-old male. The surgical report described the location of the mass as the right nipple and areola. The pathology report stated “infiltrating ductal carcinoma.” What is the correct diagnosis code?

North Carolina Subscriber

Answer: The correct diagnosis code for the case is C50.021- (Malignant neoplasm of nipple and areola, right malebreast).

The correct code family is C50, because infiltrating or invasive ductal carcinoma is a malignant tumor. Don’t confuse this condition with ductal carcinoma in situ (DCIS), which is not malignant and reports to a different code.

Men, too: Unlike ICD-9, which listed male and female breast cancer in different categories, you’ll find malignant breast cancer for both men and women described by category C50. The fifth digit describes the site on the breast where the cancer is found, such as “0” for nipple or areola. The sixth digit defines “1” for female breast of “2 for male breast. Finally, the seventh digit defines right (1), left (2) or unspecified (9) breast.