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v1.0.0
ICD-10 Guide
ICD-10 CodesD05.81

D05.81

Billable

Other specified type of carcinoma in situ of right breast

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

Code Description

ICD-10 D05.81 is a billable code used to indicate a diagnosis of other specified type of carcinoma in situ of right breast.

Key Diagnostic Point:

Carcinoma in situ (CIS) of the breast refers to 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 term 'other specified type' indicates that the carcinoma in situ does not fit into the more common categories, such as ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS). Patients diagnosed with D05.81 may present with various histological types of carcinoma in situ, necessitating careful surveillance and management. The risk of progression to invasive breast cancer varies based on the specific type of carcinoma in situ, with some types having a higher risk than others. Surveillance protocols typically include regular mammograms and clinical breast exams, with the frequency determined by the patient's risk factors and the specific characteristics of the carcinoma. The management may also involve surgical intervention, such as lumpectomy or mastectomy, depending on the extent of the disease and patient preferences. Understanding the nuances of this diagnosis is crucial for effective treatment planning and patient education.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in histological types of carcinoma in situ
  • Need for precise documentation of the type of carcinoma
  • Differentiation from invasive breast cancer codes
  • Potential for overlapping symptoms with other breast conditions

Audit Risk Factors

  • Inadequate documentation of the specific type of carcinoma
  • Failure to document the patient's risk factors for progression
  • Lack of clarity in treatment plans and follow-up protocols
  • Misclassification of carcinoma in situ as invasive cancer

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Patients undergoing surveillance after diagnosis, treatment planning discussions, and post-operative follow-ups.

Billing Considerations

Oncologists must ensure that all documentation reflects the specific type of carcinoma in situ to avoid coding errors.

Radiology

Documentation Requirements

Radiology reports must clearly indicate findings related to carcinoma in situ and any imaging follow-up.

Common Clinical Scenarios

Mammograms and breast ultrasounds for surveillance of patients with a history of carcinoma in situ.

Billing Considerations

Radiologists should correlate imaging findings with pathology results to ensure accurate coding.

Coding Guidelines

Inclusion Criteria

Use D05.81 When
  • According to ICD
  • CM guidelines, D05
  • 81 should be used when the specific type of carcinoma in situ is documented
  • It is important to ensure that the diagnosis is confirmed by pathology and that the documentation supports the diagnosis and any associated treatment

Exclusion Criteria

Do NOT use D05.81 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

19301CPT Code

Mastectomy, partial (lumpectomy)

Clinical Scenario

Used for surgical treatment of carcinoma in situ.

Documentation Requirements

Operative reports must detail the procedure and findings.

Specialty Considerations

Oncologists must ensure that the type of carcinoma is clearly documented in the operative report.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specificity in coding carcinoma in situ, enabling better tracking of treatment outcomes and resource allocation. D05.81 provides a clear designation for other specified types, which aids in research and epidemiological studies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specificity in coding carcinoma in situ, enabling better tracking of treatment outcomes and resource allocation. D05.81 provides a clear designation for other specified types, which aids in research and epidemiological studies.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specificity in coding carcinoma in situ, enabling better tracking of treatment outcomes and resource allocation. D05.81 provides a clear designation for other specified types, which aids in research and epidemiological studies.

Resources

Clinical References

  • •
    American Cancer Society - Breast Cancer

Coding & Billing References

  • •
    American Cancer Society - Breast Cancer

Frequently Asked Questions

What is the difference between carcinoma in situ and invasive breast cancer?

Carcinoma in situ is a non-invasive condition where abnormal cells are confined to the ducts or lobules of the breast, while invasive breast cancer has spread beyond these structures into surrounding breast tissue.