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ICD-10 Guide
ICD-10 CodesD05.80

D05.80

Billable

Other specified type of carcinoma in situ of unspecified breast

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

Code Description

ICD-10 D05.80 is a billable code used to indicate a diagnosis of other specified type of carcinoma in situ of unspecified breast.

Key Diagnostic Point:

Carcinoma in situ (CIS) of the breast refers to a group of abnormal cells that are found in the lining of the breast ducts or lobules but have not invaded surrounding breast tissue. The term 'other specified type' indicates that the carcinoma does not fit into the more commonly classified types such as ductal or lobular carcinoma in situ. This condition is often detected through mammography or breast biopsy and is considered a non-invasive form of breast cancer. While CIS is not life-threatening, it is a significant risk factor for developing invasive breast cancer in the future. Surveillance protocols typically include regular mammograms and clinical breast exams, with some patients requiring additional imaging or biopsies based on their risk factors. The progression risk varies, with studies indicating that women with CIS have a 20-30% chance of developing invasive breast cancer within 10 years. Therefore, careful monitoring and management are essential to ensure early detection and treatment of any progression to invasive disease.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of carcinoma types
  • Need for precise clinical details to differentiate from other breast conditions
  • Potential for overlapping diagnoses in breast pathology
  • Changes in treatment protocols that may affect coding

Audit Risk Factors

  • Inadequate documentation of the type of carcinoma
  • Failure to document patient risk factors for progression
  • Misclassification of carcinoma types
  • Inconsistent follow-up documentation

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Patients diagnosed with CIS undergoing surveillance or treatment.

Billing Considerations

Ensure accurate coding based on pathology findings and treatment protocols.

Radiology

Documentation Requirements

Clear imaging reports and findings related to breast examinations.

Common Clinical Scenarios

Mammography findings leading to biopsy for CIS diagnosis.

Billing Considerations

Radiologists must provide detailed descriptions of imaging findings to support coding.

Coding Guidelines

Inclusion Criteria

Use D05.80 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation

Exclusion Criteria

Do NOT use D05.80 When
  • Exclude conditions that are not classified as carcinoma in situ

Related ICD-10 Codes

Related CPT Codes

19120CPT Code

Excision, breast, tumor, open, excisional biopsy

Clinical Scenario

Used when a biopsy is performed to confirm CIS diagnosis.

Documentation Requirements

Pathology report confirming CIS and operative notes.

Specialty Considerations

Oncologists must ensure accurate coding based on biopsy results.

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, improving the accuracy of data collection and reimbursement processes. D05.80 provides a distinct classification for other specified types of CIS, which aids in better tracking and management of breast cancer cases.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast conditions, improving the accuracy of data collection and reimbursement processes. D05.80 provides a distinct classification for other specified types of CIS, which aids in better tracking and management of breast cancer cases.

Reimbursement & Billing Impact

reimbursement processes. D05.80 provides a distinct classification for other specified types of CIS, which aids in better tracking and management of breast cancer cases.

Resources

Clinical References

  • •
    American Cancer Society - Breast Cancer

Coding & Billing References

  • •
    American Cancer Society - Breast Cancer

Frequently Asked Questions

What is the significance of carcinoma in situ?

Carcinoma in situ is a critical marker for breast cancer risk, indicating that while the cancer is non-invasive, it has the potential to progress to invasive cancer if not monitored and managed appropriately.