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v1.0.0
ICD-10 Guide
ICD-10 CodesD05.01

D05.01

Billable

Lobular carcinoma in situ of right breast

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

Code Description

ICD-10 D05.01 is a billable code used to indicate a diagnosis of lobular carcinoma in situ of right breast.

Key Diagnostic Point:

Lobular carcinoma in situ (LCIS) of the right breast is a non-invasive form of breast cancer characterized by the proliferation of atypical lobular cells within the lobules of the breast. Unlike invasive breast cancer, LCIS does not invade surrounding breast tissue or metastasize to other parts of the body. However, it is considered a marker for increased risk of developing invasive breast cancer in either breast in the future. Patients diagnosed with LCIS often undergo regular surveillance, including clinical breast exams and imaging studies such as mammograms or MRIs, to monitor for any changes. The diagnosis of LCIS is typically made through a biopsy, and it is essential for healthcare providers to differentiate it from other breast lesions, as the management and follow-up protocols differ significantly. While LCIS itself is not life-threatening, its presence necessitates careful monitoring and may lead to discussions about preventive measures, including chemoprevention or prophylactic mastectomy, depending on individual risk factors and patient preferences.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from invasive lobular carcinoma
  • Need for precise documentation of laterality
  • Potential for co-existing conditions requiring additional coding
  • Variability in treatment protocols based on patient risk factors

Audit Risk Factors

  • Inadequate documentation of diagnosis
  • Failure to specify laterality
  • Misclassification as invasive carcinoma
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging results, and treatment plans.

Common Clinical Scenarios

Diagnosis of LCIS during routine screening, management of patients with a family history of breast cancer.

Billing Considerations

Ensure accurate staging and follow-up plans are documented.

Radiology

Documentation Requirements

Imaging reports that clearly indicate findings related to LCIS.

Common Clinical Scenarios

Mammography or MRI follow-ups for patients with a history of LCIS.

Billing Considerations

Documentation must specify the reason for imaging and any findings related to LCIS.

Coding Guidelines

Inclusion Criteria

Use D05.01 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the diagnosis, laterality, and any associated conditions
  • LCIS is classified under neoplasms, and specific guidelines for breast cancer coding should be adhered to

Exclusion Criteria

Do NOT use D05.01 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

77067CPT Code

Breast MRI

Clinical Scenario

Used for surveillance in patients with a history of LCIS.

Documentation Requirements

Indication for MRI and previous imaging results.

Specialty Considerations

Radiologists should document findings related to LCIS.

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 accuracy of data collection and enhancing the ability to track patient outcomes and treatment efficacy.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of lobular carcinoma in situ, improving the accuracy of data collection and enhancing the ability to track patient outcomes and treatment efficacy.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of lobular carcinoma in situ, improving the accuracy of data collection and enhancing the ability to track patient outcomes and treatment efficacy.

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 in the future.

How is LCIS diagnosed?

LCIS is typically diagnosed through a biopsy, often following an abnormal mammogram or clinical examination. Pathological evaluation reveals atypical lobular cells.

What are the treatment options for LCIS?

Treatment options for LCIS may include increased surveillance, chemoprevention with medications like tamoxifen, or prophylactic mastectomy, depending on individual risk factors and patient preferences.