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ICD-10 Coding for Lumpectomy(C50.911)

Complete ICD-10-CM coding and documentation guide for Lumpectomy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Partial MastectomyBreast-Conserving Surgery

Related ICD-10 Code Ranges

Complete code families applicable to Lumpectomy

C50.0-C50.9Primary Range

Malignant neoplasm of breast

This range includes codes for breast cancer, which is the primary condition treated with lumpectomy.

Key Information: ICD-10 code for lumpectomy

Essential facts and insights about Lumpectomy

The ICD-10 code for lumpectomy when performed for breast cancer is C50.911.

Primary ICD-10-CM Code for lumpectomy

Malignant neoplasm of unspecified site of right female breast
Billable Code

Decision Criteria

clinical Criteria

  • Presence of malignant breast tumor

Applicable To

  • Breast cancer

Excludes

  • Benign breast lesions

Clinical Validation Requirements

  • Pathology report confirming malignancy
  • Operative note specifying margin assessment

Code-Specific Risks

  • Incorrect use for benign conditions

Coding Notes

  • Ensure documentation specifies oncologic intent and margin assessment.

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Sentinel node biopsy

38525
Use when sentinel node biopsy is performed alongside lumpectomy.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Benign neoplasm of breast

D24.1
Use for benign breast lesions without oncologic intent.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Lumpectomy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C50.911.

Impact

Clinical: Inadequate treatment documentation, Regulatory: Non-compliance with surgical standards, Financial: Potential claim denials

Mitigation Strategy

Use standardized templates, Verify margin details before submission

Impact

Reimbursement: Incorrect billing leading to denials, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate clinical data reporting

Mitigation Strategy

Use code 19120 for benign lesions without oncologic intent.

Impact

Failure to document margin status can trigger audits.

Mitigation Strategy

Implement mandatory margin documentation protocols.

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 Lumpectomy, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Lumpectomy

Use these documentation templates to ensure complete and accurate documentation for Lumpectomy. These templates include all required elements for proper coding and billing.

Oncologic lumpectomy with sentinel node biopsy

Specialty: Surgical Oncology

Required Elements

  • Lesion localization method
  • Margin inking and orientation
  • Sentinel node identification

Example Documentation

Procedure: Lumpectomy (19301) with sentinel node biopsy. Findings: Lesion localized via ultrasound, margins inked, sentinel nodes identified.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Mass excised from breast.
Good Documentation Example
4.2 cm lumpectomy specimen oriented with long stitch lateral, short stitch superior. Frozen section confirms negative margins.
Explanation
The good example includes specific orientation and margin status, essential for coding.

Need help with ICD-10 coding for Lumpectomy? Ask your questions below.

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