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v1.0.0
ICD-10 Guide
ICD-10 CodesChapter 2: NeoplasmsD05

D05

Billable

Carcinoma in situ of breast

Chapter 2:Neoplasms

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 D05 is a billable code used to indicate a diagnosis of carcinoma in situ of breast.

Key Diagnostic Point:

Carcinoma in situ of the breast refers to a non-invasive form of breast cancer where abnormal cells are found in the lining of the breast ducts or lobules but have not spread to surrounding breast tissue. This condition is often detected through mammography or breast biopsy and is classified into two main types: ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). DCIS is more common and is characterized by the presence of cancerous cells in the milk ducts, while LCIS is considered a marker for increased risk of developing breast cancer in the future. Patients diagnosed with carcinoma in situ typically have a favorable prognosis, but they require careful monitoring and management to prevent progression to invasive breast cancer. Treatment options may include surgery, radiation therapy, and hormone therapy, depending on the specific characteristics of the carcinoma and patient preferences. Surveillance protocols often involve regular mammograms and clinical breast exams to monitor for any changes that may indicate progression. The risk of progression to invasive cancer varies, with studies suggesting that approximately 30% of women with untreated DCIS may develop invasive breast cancer within 10 years.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between DCIS and LCIS for accurate coding.
  • Understanding the implications of treatment options on coding.
  • Navigating the nuances of surveillance protocols.
  • Keeping up with evolving guidelines and recommendations.

Audit Risk Factors

  • Inadequate documentation of the type of carcinoma in situ.
  • Failure to document treatment plans and follow-up care.
  • Misclassification of DCIS as invasive cancer.
  • Lack of clarity in pathology reports.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, treatment plans, and follow-up care documentation.

Common Clinical Scenarios

Diagnosis of DCIS or LCIS, treatment planning, and post-treatment surveillance.

Billing Considerations

Ensure accurate staging and grading of the carcinoma for proper coding.

Radiology

Documentation Requirements

Clear imaging reports and findings related to breast screenings.

Common Clinical Scenarios

Mammography findings leading to biopsy and diagnosis of carcinoma in situ.

Billing Considerations

Documenting the rationale for imaging and follow-up recommendations.

Coding Guidelines

Inclusion Criteria

Use D05 When
  • According to the official ICD
  • CM guidelines, D05 should be used when the diagnosis of carcinoma in situ is confirmed by pathology
  • It is essential to document the specific type of carcinoma in situ and any associated treatment or follow
  • up care

Exclusion Criteria

Do NOT use D05 When
No specific exclusions found.

Related CPT Codes

19301CPT Code

Mastectomy, partial (segmental)

Clinical Scenario

Used for surgical treatment of DCIS.

Documentation Requirements

Operative report detailing the procedure and diagnosis.

Specialty Considerations

Oncology specialists must ensure accurate coding based on the surgical approach.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of carcinoma in situ, improving the ability to track and manage this condition. The granularity of the codes helps in understanding treatment outcomes and patient demographics.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of carcinoma in situ, improving the ability to track and manage this condition. The granularity of the codes helps in understanding treatment outcomes and patient demographics.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of carcinoma in situ, improving the ability to track and manage this condition. The granularity of the codes helps in understanding treatment outcomes and patient demographics.

Resources

Clinical References

  • •
    American Cancer Society - Breast Cancer

Coding & Billing References

  • •
    American Cancer Society - Breast Cancer

Frequently Asked Questions

What is the difference between DCIS and LCIS?

DCIS is a non-invasive cancer that can progress to invasive cancer if untreated, while LCIS is not considered a cancer but indicates an increased risk of developing breast cancer in the future.