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ICD-10 Guide
ICD-10 CodesD05.12

D05.12

Billable

Intraductal carcinoma in situ of left breast

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

Code Description

ICD-10 D05.12 is a billable code used to indicate a diagnosis of intraductal carcinoma in situ of left breast.

Key Diagnostic Point:

Intraductal carcinoma in situ (DCIS) of the left breast is a non-invasive form of breast cancer characterized by the presence of abnormal cells within the ducts of the breast tissue. These cells have not invaded surrounding breast tissue, which differentiates DCIS from invasive breast cancer. DCIS is often detected through mammography as microcalcifications and may present with no palpable mass. The risk of progression to invasive breast cancer varies, with estimates suggesting that approximately 25-30% of women with untreated DCIS may develop invasive cancer within 10 years. Surveillance protocols typically include regular mammograms and clinical breast exams, with treatment options ranging from lumpectomy and radiation therapy to mastectomy, depending on the extent of the disease and patient preferences. The prognosis for DCIS is generally favorable, but careful monitoring is essential to manage the risk of progression.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from invasive breast cancer codes
  • Need for precise documentation of laterality
  • Variability in treatment protocols and follow-up care
  • Potential for misclassification with other breast conditions

Audit Risk Factors

  • Inadequate documentation of diagnosis
  • Failure to specify laterality
  • Misuse of codes for invasive vs. non-invasive conditions
  • Inconsistent follow-up documentation

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging results, and treatment plans.

Common Clinical Scenarios

Diagnosis of DCIS following mammography, treatment planning discussions.

Billing Considerations

Ensure accurate staging and grading of the carcinoma.

Radiology

Documentation Requirements

Clear imaging reports indicating findings of DCIS.

Common Clinical Scenarios

Mammography findings leading to biopsy and diagnosis.

Billing Considerations

Documentation of imaging techniques and findings is crucial.

Coding Guidelines

Inclusion Criteria

Use D05.12 When
  • According to ICD
  • CM guidelines, D05
  • 12 should be used when the diagnosis of intraductal carcinoma in situ is confirmed through pathology
  • It is important to document the laterality and ensure that the diagnosis is not confused with invasive breast cancer

Exclusion Criteria

Do NOT use D05.12 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

19301CPT Code

Mastectomy, partial (lumpectomy)

Clinical Scenario

Performed for treatment of DCIS.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Oncology specialists should ensure accurate coding of the procedure.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like DCIS, improving data accuracy and enhancing the ability to track treatment outcomes and epidemiological trends.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like DCIS, improving data accuracy and enhancing the ability to track treatment outcomes and epidemiological trends.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like DCIS, improving data accuracy and enhancing the ability to track treatment outcomes and epidemiological trends.

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 invasive breast cancer?

DCIS is a non-invasive condition where abnormal cells are confined to the ducts of the breast, while invasive breast cancer involves the spread of cancerous cells beyond the ducts into surrounding breast tissue.