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Breast Neoplasm - which diagnosis?

  1. Default Breast Neoplasm - which diagnosis?
    Medical Coding Books
    Diagnosis codes 238.3 and 239.3 are very close. Do you have any hints for when to use each?

  2. #2
    Default breast neoplasm
    I grabbed my 2013 CHONC study manual to answer this question (page 12).
    A common neoplasm coding error is determining between unspecified and uncertain behavior. Uncertain behavior is described in ICD: Categories 235-238by site certain histomorphologically well defined neoplasm, the subsequent behavior of which cannot be predicted from the present appearance.
    Histomorphologically means that you can only use those codes if a physician - your physician or a pathologist - has examined the tissue under a microscope and determined that the tissue is ambiguous and cannot be assigned a malignant or benign designation. Codes from that category cannot be assigned if no microscopic examination has occurred. Instead, unspecified codes should be used if the claim must be filed before a pathology report is issued.
    I hope this helps clarifies the difference.
    Thanks,
    Dana Chock, CPC, CCA, CANPC, CHONC
    Anesthesia, Pathology, & Laboratory

  3. #3
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    Default
    If you look in the code book under sub chapter for neoplasm of unspecified nature it state that the term "mass" ( in quotes it mean to include similar terms like lesion or bump) does not mean neoplasm and should be coded to mass or similar term.
    Coding clinics state that after a preliminary workup such as a scan or ultrasound or even biopsy if the interpretation states tumor or growth then you code it as neoplasm unspecified. It is unspecified because it is not possible for the provider to know path results when it has yet to be requested.

    Neoplasm of uncertain behavior requires a path report as stated in the previous response.

    Debra A. Mitchell, MSPH, CPC-H

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