ICD-10 Coding for Triple-Negative Breast Cancer(C50.411, Z17.01)
Complete ICD-10-CM coding and documentation guide for Triple-Negative Breast Cancer. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Triple-Negative 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 |
|---|---|---|---|
| C50.411 | Malignant neoplasm of upper-outer quadrant of right female breast | Use when the tumor is located in the upper-outer quadrant of the right breast. |
|
| Z17.01 | Estrogen receptor negative, progesterone receptor negative, HER2 negative status | Use to specify triple-negative receptor status in breast cancer. |
|
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 triple-negative breast cancer
Essential facts and insights about Triple-Negative Breast Cancer
Primary ICD-10-CM Codes for triple negative breast cancer
Decision Criteria
clinical Criteria
- Tumor confirmed in upper-outer quadrant of right breast
documentation Criteria
- Receptor status documented as triple-negative
Applicable To
- Breast cancer located in the upper-outer quadrant
Excludes
- Benign neoplasm of breast
Clinical Validation Requirements
- Pathology report confirming malignant neoplasm
- Documentation of tumor location and laterality
Code-Specific Risks
- Incorrect laterality documentation
- Omission of receptor status
Coding Notes
- Ensure documentation includes receptor status and laterality.
Z17.01 - Estrogen receptor negative, progesterone receptor negative, HER2 negative status
Use to specify triple-negative receptor status in breast cancer.
Applicable To
- Triple-negative receptor status
Excludes
- Receptor positive breast cancer
Clinical Validation Requirements
- IHC/ISH test results showing ER, PR, HER2 negativity
Coding Notes
Ensure test results are documented to support this code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Secondary malignant neoplasm of bone
C79.81Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Unspecified malignant neoplasm of breast
C50.919Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Triple-Negative Breast Cancer to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C50.411.
Impact
Clinical: Misrepresentation of cancer type, Regulatory: Non-compliance with coding standards, Financial: Potential reimbursement issues
Mitigation Strategy
Ensure all pathology reports include receptor status, Regular audits of documentation
Impact
Reimbursement: May result in incorrect DRG assignment, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate clinical data representation
Mitigation Strategy
Always pair with Z17.01 to indicate triple-negative status.
Impact
Failure to document receptor status can lead to audit issues.
Mitigation Strategy
Implement regular documentation audits and training.
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 Triple-Negative Breast Cancer, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Triple-Negative Breast Cancer
Use these documentation templates to ensure complete and accurate documentation for Triple-Negative Breast Cancer. These templates include all required elements for proper coding and billing.
Initial diagnosis of TNBC
Specialty: OncologyRequired Elements
- Tumor location
- Receptor status
- Genetic testing results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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