Pathology/Lab Coding Alert

Question: The pathologist examines an FNA from a "breast mass" and is unable to provide a definitive diagnosis. Would the appropriate diagnosis be "breast neoplasm of uncertain behavior"?Texas SubscriberAnswer: You should not use an uncertain behavior code, such as 238.3 (Neoplasm of uncertain behavior of breast) if the pathologist does not provide a definitive diagnosis.In the scenario you describe, a code such as 611.72 (Lump or mass in breast) would be more appropriate. Here's why: Uncertain behavior codes are appropriate when the pathologist identifies a neoplasm that exhibits characteristics indicating that it might become malignant. The cells may be undergoing a transformation to malignancy, but the pathologist cannot make a clear distinction between benign and malignant.If the tumor has an unpredictable behavior, it then fits in the neoplasm of uncertain behavior category. ICD-9 describes these tumors as "histomorphologically well-defined neoplasms, the subsequent behavior of which cannot be predicted from the [...]