ICD-10 Coding for Malignant Tumor of Breast(C50.011, C50.212)
Complete ICD-10-CM coding and documentation guide for Malignant Tumor of Breast. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Malignant Tumor of Breast
C50.0-C50.9Primary Range
Malignant neoplasm of breast
This range covers all malignant neoplasms of the breast, specifying location and laterality.
Secondary malignant neoplasm of liver
Used for coding liver metastasis from a primary breast cancer.
Secondary malignant neoplasm of brain
Used for coding brain metastasis from a primary breast cancer.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C50.011 | Malignant neoplasm of nipple and areola, right female breast | Use when the primary site of the breast cancer is the nipple and areola of the right breast. |
|
| C50.212 | Malignant neoplasm of upper-inner quadrant of left female breast | Use when the primary site of the breast cancer is the upper-inner quadrant of the left breast. |
|
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 malignant neoplasm of breast
Essential facts and insights about Malignant Tumor of Breast
Primary ICD-10-CM Codes for malignant tumor of breast
Decision Criteria
clinical Criteria
- Confirmed invasive carcinoma of nipple and areola
documentation Criteria
- Documentation of right breast involvement
Applicable To
- Invasive carcinoma of nipple and areola
Excludes
- Benign neoplasm of nipple and areola
Clinical Validation Requirements
- Pathology report confirming invasive carcinoma
- Documentation of laterality
Code-Specific Risks
- Incorrect laterality documentation
- Missing histological confirmation
Coding Notes
- Ensure documentation specifies the exact site and laterality.
C50.212 - Malignant neoplasm of upper-inner quadrant of left female breast
Use when the primary site of the breast cancer is the upper-inner quadrant of the left breast.
Applicable To
- Invasive carcinoma of upper-inner quadrant
Excludes
- Benign neoplasm of upper-inner quadrant
Clinical Validation Requirements
- Pathology report confirming invasive carcinoma
- Documentation of quadrant and laterality
Coding Notes
Ensure documentation specifies the exact quadrant and laterality.
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 Malignant Tumor of Breast to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C50.011.
Impact
Clinical: Impacts treatment decisions and eligibility for targeted therapies., Regulatory: Non-compliance with documentation standards., Financial: May affect reimbursement for targeted therapies.
Mitigation Strategy
Include receptor status in all pathology reports, Verify documentation completeness before coding
Impact
Reimbursement: May lead to reduced reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases the quality and specificity of health data.
Mitigation Strategy
Always document and code the specific site and laterality of the tumor.
Impact
Using unspecified codes when specific ones are available.
Mitigation Strategy
Educate providers on the importance of detailed documentation.
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 Malignant Tumor of Breast, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Malignant Tumor of Breast
Use these documentation templates to ensure complete and accurate documentation for Malignant Tumor of Breast. These templates include all required elements for proper coding and billing.
Documenting invasive ductal carcinoma
Specialty: OncologyRequired Elements
- Histological type
- Tumor location
- Laterality
- Receptor status
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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