ICD-10 Coding for Ductal Carcinoma In Situ (DCIS) of the Breast(D05.1, Z85.3)
Complete ICD-10-CM coding and documentation guide for Ductal Carcinoma In Situ (DCIS) of the Breast. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Ductal Carcinoma In Situ (DCIS) of the Breast
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| D05.1 | Intraductal carcinoma in situ | Use when DCIS is confirmed by biopsy without invasive components. |
|
| Z85.3 | Personal history of malignant neoplasm of breast | Use for patients with a history of DCIS after complete excision. |
|
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 ductal carcinoma in situ breast
Essential facts and insights about Ductal Carcinoma In Situ (DCIS) of the Breast
Primary ICD-10-CM Codes for ductal carcinoma in situ breast
Decision Criteria
clinical Criteria
- Biopsy confirms DCIS without invasion
documentation Criteria
- Pathology report specifies nuclear grade and margin status
Applicable To
- DCIS of the breast
Excludes
- Invasive carcinoma of the breast (C50.-)
Clinical Validation Requirements
- Biopsy confirmation of DCIS
- Nuclear grade and margin status
Code-Specific Risks
- Incorrectly coding suspected DCIS as confirmed
Coding Notes
- Ensure documentation specifies 'confirmed DCIS' with details on grade and location.
Z85.3 - Personal history of malignant neoplasm of breast
Use for patients with a history of DCIS after complete excision.
Applicable To
- History of breast cancer
Excludes
- Current DCIS (D05.-)
Clinical Validation Requirements
- Documentation of complete excision of DCIS
- No residual disease on follow-up
Coding Notes
Ensure follow-up documentation confirms no residual disease.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Personal history of malignant neoplasm of breast
Z85.3Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Ductal Carcinoma In Situ (DCIS) of the Breast to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code D05.1.
Impact
Clinical: Misrepresentation of patient's current treatment status., Regulatory: Potential audit issues due to incorrect coding., Financial: Inaccurate billing and potential claim denials.
Mitigation Strategy
Verify treatment status before coding, Review pathology reports for residual disease
Impact
Reimbursement: Incorrect reimbursement due to inappropriate code usage., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Use symptom codes until biopsy confirms DCIS.
Impact
Discrepancies between imaging findings and pathology reports can trigger audits.
Mitigation Strategy
Ensure all findings are reconciled and documented accurately.
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 Ductal Carcinoma In Situ (DCIS) of the Breast, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Ductal Carcinoma In Situ (DCIS) of the Breast
Use these documentation templates to ensure complete and accurate documentation for Ductal Carcinoma In Situ (DCIS) of the Breast. These templates include all required elements for proper coding and billing.
Post-lumpectomy follow-up
Specialty: OncologyRequired Elements
- Pathology results
- Margin status
- Follow-up plan
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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