ICD-10 Coding for Metastatic Breast Carcinoma(C50.912, C79.51)
Complete ICD-10-CM coding and documentation guide for Metastatic Breast Carcinoma. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Metastatic Breast Carcinoma
C50.0-C50.9Primary Range
Malignant neoplasm of breast
Primary codes for breast cancer, specifying location and laterality.
Secondary malignant neoplasms of brain and bone
Codes for metastases to specific sites like brain and bone.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C50.912 | Malignant neoplasm of unspecified site of left female breast | Use when the primary site is confirmed as the left breast but specific quadrant is not documented. |
|
| C79.51 | Secondary malignant neoplasm of bone | Use when metastasis to bone is confirmed. |
|
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 metastatic breast carcinoma
Essential facts and insights about Metastatic Breast Carcinoma
Primary ICD-10-CM Codes for metastatic breast carcinoma
Decision Criteria
documentation Criteria
- Document laterality and specific site for accurate coding.
Applicable To
- Breast cancer, NOS
Excludes
- Benign neoplasm of breast
Clinical Validation Requirements
- Pathology report confirming invasive ductal carcinoma
- Imaging showing primary breast tumor
Code-Specific Risks
- Risk of unspecified coding if quadrant is known but not documented.
Coding Notes
- Ensure laterality is documented to avoid unspecified coding.
C79.51 - Secondary malignant neoplasm of bone
Use when metastasis to bone is confirmed.
Applicable To
- Bone metastasis
Excludes
- Primary bone cancer
Clinical Validation Requirements
- Bone scan showing metastatic lesions
- Biopsy confirming breast origin
Coding Notes
Ensure primary site is documented if known.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for antineoplastic chemotherapy
Z51.11Differential 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 Metastatic Breast Carcinoma to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C50.912.
Impact
Clinical: May affect treatment decisions., Regulatory: Increases audit risk., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Always document laterality in clinical notes.
Impact
Reimbursement: May lead to reduced reimbursement due to unspecified coding., Compliance: Increases risk of audit findings., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Query provider for specific site and laterality.
Impact
Using unspecified codes when specific details are available.
Mitigation Strategy
Ensure documentation includes specific site and laterality.
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 Metastatic Breast Carcinoma, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Metastatic Breast Carcinoma
Use these documentation templates to ensure complete and accurate documentation for Metastatic Breast Carcinoma. These templates include all required elements for proper coding and billing.
Metastatic breast cancer with bone metastasis
Specialty: OncologyRequired Elements
- Primary site documentation
- Metastasis site confirmation
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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