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ICD-10 Guide
ICD-10 CodesD05.91

D05.91

Billable

Unspecified type of carcinoma in situ of right breast

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

Code Description

ICD-10 D05.91 is a billable code used to indicate a diagnosis of unspecified type of carcinoma in situ of right breast.

Key Diagnostic Point:

Carcinoma in situ (CIS) of the breast is 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 tissues. The unspecified type indicates that the specific histological subtype of carcinoma in situ has not been determined. This condition is often detected through mammography or breast biopsy and is characterized by the presence of atypical cells that have the potential to develop into invasive cancer if left untreated. Surveillance protocols typically involve regular imaging studies and clinical examinations to monitor for any changes in the breast tissue. The risk of progression to invasive carcinoma varies based on factors such as the patient's age, family history, and the presence of other risk factors. Early detection and treatment are crucial in managing this condition, as timely intervention can significantly reduce the risk of progression to invasive breast cancer.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified type may lead to ambiguity in treatment planning.
  • Requires precise documentation of clinical findings.
  • Potential for misclassification with other breast conditions.
  • Need for thorough understanding of breast cancer staging.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to specify the type of carcinoma in situ.
  • Inconsistent coding practices among different providers.
  • Lack of follow-up documentation for surveillance protocols.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Initial diagnosis of carcinoma in situ, treatment planning, and follow-up care.

Billing Considerations

Ensure accurate staging and histological classification to guide treatment.

Radiology

Documentation Requirements

Clear imaging reports indicating findings related to carcinoma in situ.

Common Clinical Scenarios

Mammography findings leading to biopsy recommendations.

Billing Considerations

Documentation must correlate with clinical findings and treatment decisions.

Coding Guidelines

Inclusion Criteria

Use D05.91 When
  • According to ICD
  • 10 coding guidelines, D05
  • 91 should be used when the specific type of carcinoma in situ is not documented
  • Coders must ensure that the diagnosis is supported by clinical documentation and that the right breast is specified

Exclusion Criteria

Do NOT use D05.91 When
  • Exclusion criteria include cases where the carcinoma has progressed to invasive cancer

Related ICD-10 Codes

Related CPT Codes

19120CPT Code

Excision, breast, tumor

Clinical Scenario

Used when excising a carcinoma in situ lesion.

Documentation Requirements

Pathology report confirming carcinoma in situ.

Specialty Considerations

Oncology specialists must ensure accurate coding based on surgical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of breast conditions, including carcinoma in situ. D05.91 provides a clear designation for unspecified types, aiding in tracking and treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast conditions, including carcinoma in situ. D05.91 provides a clear designation for unspecified types, aiding in tracking and treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of breast conditions, including carcinoma in situ. D05.91 provides a clear designation for unspecified types, aiding in tracking and treatment planning.

Resources

Clinical References

  • •
    American Cancer Society - Breast Cancer

Coding & Billing References

  • •
    American Cancer Society - Breast Cancer

Frequently Asked Questions

What does carcinoma in situ mean?

Carcinoma in situ refers to a group of abnormal cells that are confined to the site of origin and have not invaded surrounding tissues. It is considered a non-invasive form of cancer.