ICD-10 Coding for Breast Cancer with Metastasis(C50.911, C79.51)
Complete ICD-10-CM coding and documentation guide for Breast Cancer with Metastasis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Cancer with Metastasis
C50.0-C50.9Primary Range
Malignant neoplasm of breast
Primary codes for breast cancer, specifying location and laterality.
Secondary malignant neoplasm of unspecified site
Used when the site of metastasis is unspecified.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C50.911 | Malignant neoplasm of unspecified site of right female breast | Use when the primary site of breast cancer is the right breast and specific site is not documented. |
|
| C79.51 | Secondary malignant neoplasm of bone | Use when there is confirmed metastasis to the bone. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for breast cancer with bone metastasis
Essential facts and insights about Breast Cancer with Metastasis
Primary ICD-10-CM Codes for breast cancer with mets
Decision Criteria
clinical Criteria
- Confirmed diagnosis of breast cancer in the right breast.
Applicable To
- Breast cancer, right side
Excludes
- Benign neoplasm of breast
Clinical Validation Requirements
- Histological confirmation of breast cancer
- Imaging showing breast mass
Code-Specific Risks
- Incorrect laterality documentation
Coding Notes
- Ensure laterality is documented accurately.
C79.51 - Secondary malignant neoplasm of bone
Use when there is confirmed metastasis to the bone.
Applicable To
- Bone metastasis
Excludes
- Primary bone cancer
Clinical Validation Requirements
- Imaging showing bone lesions
- Biopsy confirming metastatic disease
Coding Notes
Ensure documentation specifies metastasis to bone.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Breast Cancer with Metastasis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C50.911.
Impact
Clinical: Inaccurate treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential for denied claims
Mitigation Strategy
Use specific terms for metastasis sites, Ensure documentation includes imaging and biopsy results
Impact
Reimbursement: Incorrect DRG assignment leading to potential underpayment., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Sequence the secondary site first if treatment focuses on metastasis.
Impact
Inadequate documentation of metastasis sites.
Mitigation Strategy
Ensure all imaging and biopsy results are documented.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Breast Cancer with Metastasis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Breast Cancer with Metastasis
Use these documentation templates to ensure complete and accurate documentation for Breast Cancer with Metastasis. These templates include all required elements for proper coding and billing.
Metastatic breast cancer with bone involvement
Specialty: OncologyRequired Elements
- Patient history
- Imaging results
- Biopsy findings
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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