Wiki Breast Cancer Coding Problem

[bvilla7@brighthouse.com]

Here is the scenario that I need help with: a patient is diagnosed in 2005 with DCIS. I coded her with V13.89 for the history of DCIS. In 2014, a bone biopsy was done which is diagnosed as metastatic breast cancer but mammograms and scans are not showing any abnormality in the breasts. My thought process is that because this is 9 years later, it is a new breast primary and I would code 174.9 and 198.5. It can't be in situ any more because it obviously is now invasive. Any thoughts? I'm not sure if I am correct.

 

[mitchellde]

The bone is the metastatic site but from what you have stated the primary was not indicated. You can not assume the primary was the breast so no you would use 199.1 as primary unknown unless there is more information indicating the breast is primary and active.

 

[bvilla7@brighthouse.com]

The diagnosis from the bone biopsy specimen is metastatic from breast primary but scans and mammogram do not show an abnormality in the breast.