Understand Uncertain Does Not Mean Unspecified
Question: What does it mean when a pathologist describes a neoplasm of the breast as uncertain, and how is that different from being unspecified? Revenue Cycle Insider Subscriber Answer: The terms “uncertain” and “unspecified” have completely different meanings in diagnosis coding and should never be used interchangeably. Pathologists will use the term “uncertain” when “histologic confirmation whether the neoplasm is malignant or benign cannot be made,” per the note for the “Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48)” codes. Alternatively, pathologists will assign an unspecified behavior designation to a neoplasm “when the information in the medical record is insufficient to assign a more specific code,” per ICD-10-CM Guideline I.A.9.b. In other words, you should assign an unspecified code when the provider is certain that a patient has cancer, but you cannot assign a more specific code for that cancer. Fortunately, once the pathologist has assigned a status of uncertain or unspecified to the breast tissue sample under analysis, you can determine the correct diagnosis code easily by going to the ICD-10-CM Table of Neoplasms. There, you will look up Breast in the alphabetical list of neoplasms (the first column of the table), then go to the sixth and seventh columns of the table, where you will find D48.6- (Neoplasm of uncertain behavior of breast) listed as the code for uncertain cancer of the breast and D49.3- (Neoplasm of unspecified behavior of breast) as the code for unspecified cancer of the breast. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
