Wiki dx question

AnnaE

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microinvasive ductal carcinoma of the left breast that is ER-positive - is this still dcis wi dx 233.0? Thanks
 
Dcis

The key words are ductal carcinoma. Microinvasive (http://www.ncbi.nlm.nih.gov/pubmed/12828606, just read the abstract) characterizes the gross anatomy of the carcinoma, most likely with very few cancer cells infiltrating beyond the duct. That is my guess without reading the pathology report. ER-positive means that based upon molecular (fluorescent) tests, the patient is estrogen receptor positive, which helps the oncologist target treatment. The test really has nothing to do with assigning a diagnostic code. So, the patient has DCIS, but with some cells invading past the ductal membranes. I have never seen a medical record with ductal carcinoma other than as a primary malignancy, so 233.0 seems correct for the DCIS. However, the pathology report states microinvasive, so you also need to code for that (see https://www.aapc.com/memberarea/forums/showthread.php?t=112143). Without having the pathology report, one would have to code 174.9, but you should certainly review the report, which would specify where the biopsy tissue was obtained. Enjoy.

Peter Cooper, BA, CRT(RT), CPC
San Francisco Chapter member
 
Don't forget to code the Estrogen Receptor

Hi,
Friendly reminder ~
Please remember when coding breast cancer and the Estrogen Receptor results are available to code those also. ICD 9 Estrogen Receptor positive V86.0 or negative V86.1 and for ICD 10 Z17.0 for positive and Z17.1for negative.
Thanks,
Dana Chock, CPC, CCA, CANPC, CHONC, CPMA, CPB
 
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