Wiki Clarification on DX Breast Cancer

Messages
2
Best answers
0
Hello All,
I work for a plastic surgeon that specializes in Breast reconstruction post mastectomy. I recently passed my CPC exam and have began coding for EM. I also code pre-certs for surgeries. My coders have been taking the lazy route and code C50.911/.912/.919. I am trying to be as accurate as possible and am running into some issues I was hoping someone can help clarify. I have looked into the guidelines of the chapter and can't find a definitive answer.

1. If a neoplasm is listed at 12:00 Left breast, would you code for the UOQ (C50.412), Central Portion (C50.112), UIQ (C50.212) or overlapping sites (C50.812)?
Same question for 3:00 axis of left breast, would it be UOQ, LOQ, Central, or overlapping?

2. If a patient is listed as having DCIS in the UOQ of the left breast, would you code D05.12 in conjunction with C50.412?

3. If a patient is listed as having LCIS in multiple sites of BOTH breasts, would you code D05.01, D05.02 and then add a code for overlapping sites? C50.819 Or would I add the carcinoma for specific quadrant? (IE C50.411) Or would the LCIS codes suffice for each breast?
This is what the med records list:
1. Breast, Right 2:00 1cm from nipple - Invasive ductal carcinoma (No in situ present)
2. Breast, Right 3:00 - Lobular Carcinoma in Situ (LCIS)
3. Breast, Left, Upper Outer Quadrant - LCIS

4. If you have to code for multiple sites, but also need to use a BRCA code, a Deformity code (N65.0), Personal Hx, Family Hx, etc etc....but can only use 4 CPT codes which codes would you code for over the others?


THANK YOU IN ADVANCE!!!
 
advice for breast cancer coding

I will try to help the best that I can with your questions. I recently had the opportunity to sit at a webinar from Optum on this very scenario if I recall correctly the beginning of December 2017. They provided a very useful guide with their webinar notes.

1. If a neoplasm is listed at 12:00 Left breast, would you code for the UOQ (C50.412), Central Portion (C50.112), UIQ (C50.212) or overlapping sites (C50.812)?
Same question for 3:00 axis of left breast, would it be UOQ, LOQ, Central, or overlapping?
> 12:00 left breast would be C50.8
> 3:00 left breast would be C50.8

2. (Without the actual path report to review) DCIS of left breast would only be D05.12.
I'm unsure who else sees this but it is very common to see DCIS only with no other type of neoplasm process coding pathology.

3. (Again without actual path report to review) the LCIS of both breasts would be coded with D05.01 with D05.02 for both breasts
> 2 o'clock right breast at 1 cm from nipple according to my notes would be C50.1 (if it would have been more then 1 cm it would have been C50.2)
> 3 o'clock LCIS right breast D05.01
> Upper Outer LCIS of Left breast D05.02

Please be sure to take the time to code the Estrogren Receptor Positive Z17.0 (ER+) or Estrogen Receptor Negative Z17.1 (ER-) when coding the pathology report.

Hopefully this helps,
Dana Chock CPC, CANPC, CHONC, CPMA, CPB
Anesthesia, Pathology, Laboratory, & Radiology Coder
 
Last edited:
Top