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ICD-10 Guide
ICD-10 CodesD05.00

D05.00

Billable

Lobular carcinoma in situ of unspecified breast

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

Code Description

ICD-10 D05.00 is a billable code used to indicate a diagnosis of lobular carcinoma in situ of unspecified breast.

Key Diagnostic Point:

Lobular carcinoma in situ (LCIS) of the breast is a non-invasive form of breast cancer characterized by the abnormal growth of lobular cells within the breast lobules. Unlike invasive breast cancer, LCIS does not invade surrounding breast tissue, making it a marker of increased risk for developing invasive breast cancer in either breast later in life. Patients with LCIS often present with no symptoms, and it is typically discovered incidentally during a biopsy performed for another reason. The diagnosis is confirmed through histopathological examination, which reveals the presence of atypical lobular cells. Although LCIS is not classified as breast cancer in the traditional sense, it is considered a significant risk factor, prompting close surveillance and management strategies. Patients diagnosed with LCIS are often advised to undergo regular mammograms and may be considered for additional imaging or preventive measures, such as chemoprevention or prophylactic mastectomy, depending on individual risk factors and patient preferences. Understanding the nuances of LCIS is crucial for effective patient management and risk assessment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from invasive lobular carcinoma
  • Need for precise documentation of histological findings
  • Potential for co-existing conditions requiring additional coding
  • Variability in treatment protocols and surveillance recommendations

Audit Risk Factors

  • Inadequate documentation of biopsy results
  • Failure to note patient history of breast cancer
  • Misclassification of LCIS as invasive cancer
  • Lack of follow-up documentation for surveillance protocols

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Patients diagnosed with LCIS undergoing surveillance or risk-reducing surgeries.

Billing Considerations

Ensure accurate coding of any concurrent conditions or treatments that may affect management.

Radiology

Documentation Requirements

Clear imaging reports and indications for follow-up imaging.

Common Clinical Scenarios

Imaging studies performed for patients with a history of LCIS.

Billing Considerations

Document the rationale for imaging frequency and any findings that may alter management.

Coding Guidelines

Inclusion Criteria

Use D05.00 When
  • According to ICD
  • 10 guidelines, D05
  • 00 should be used when documenting lobular carcinoma in situ without specifying laterality
  • It is essential to ensure that the diagnosis is confirmed through appropriate histological examination and that any associated risk factors are documented

Exclusion Criteria

Do NOT use D05.00 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

88305CPT Code

Pathology examination, breast biopsy

Clinical Scenario

Used when a biopsy is performed to confirm the diagnosis of LCIS.

Documentation Requirements

Pathology report detailing the findings of the biopsy.

Specialty Considerations

Oncologists should ensure that the pathology report is comprehensive and includes all relevant findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of lobular carcinoma in situ, improving the ability to track and manage patient outcomes effectively. This specificity aids in research and treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of lobular carcinoma in situ, improving the ability to track and manage patient outcomes effectively. This specificity aids in research and treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of lobular carcinoma in situ, improving the ability to track and manage patient outcomes effectively. This specificity aids in research and treatment planning.

Resources

Clinical References

  • •
    American Cancer Society - Lobular Carcinoma in Situ

Coding & Billing References

  • •
    American Cancer Society - Lobular Carcinoma in Situ

Frequently Asked Questions

What is lobular carcinoma in situ?

Lobular carcinoma in situ (LCIS) is a non-invasive breast condition where abnormal cells are found in the lobules of the breast. It is not considered breast cancer but indicates an increased risk for developing invasive breast cancer.