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v1.0.0
ICD-10 Guide
ICD-10 CodesD05.90

D05.90

Billable

Unspecified type of carcinoma in situ of unspecified breast

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

Code Description

ICD-10 D05.90 is a billable code used to indicate a diagnosis of unspecified 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. These cells have the potential to become invasive cancer but are currently non-invasive. The term 'unspecified type' indicates that the specific subtype of carcinoma in situ, such as ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS), has not been determined. Patients diagnosed with D05.90 may undergo regular surveillance protocols, including mammograms and clinical breast exams, to monitor for any changes that could indicate progression to invasive cancer. The risk of progression from carcinoma in situ to invasive breast cancer varies, with DCIS having a higher risk compared to LCIS. Factors influencing progression include tumor size, grade, and the presence of necrosis. Early detection and treatment are crucial in managing this condition, as timely intervention can significantly reduce the risk of developing invasive breast cancer.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Lack of specificity regarding the type of carcinoma in situ
  • Variability in clinical presentation and management protocols
  • Need for thorough documentation to support diagnosis
  • Potential for misclassification with other breast conditions

Audit Risk Factors

  • Inadequate documentation of the type of carcinoma in situ
  • Failure to document surveillance and follow-up plans
  • Misalignment between diagnosis and treatment provided
  • Inconsistent coding practices among different providers

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, treatment plans, and follow-up notes are essential for accurate coding.

Common Clinical Scenarios

Patients presenting with abnormal mammograms, biopsy results indicating carcinoma in situ, and those undergoing treatment or surveillance.

Billing Considerations

Oncologists must ensure that the type of carcinoma in situ is clearly documented to avoid coding errors.

Radiology

Documentation Requirements

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

Common Clinical Scenarios

Imaging studies performed for patients with a known diagnosis of carcinoma in situ or those with suspicious findings.

Billing Considerations

Radiologists should provide comprehensive reports that correlate imaging findings with clinical history.

Coding Guidelines

Inclusion Criteria

Use D05.90 When
  • According to ICD
  • CM guidelines, D05
  • 90 should be used when the specific type of carcinoma in situ is not documented
  • Coders must ensure that the diagnosis is supported by clinical documentation and that it aligns with the treatment provided

Exclusion Criteria

Do NOT use D05.90 When
No specific exclusions found.

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 a diagnosis of carcinoma in situ.

Documentation Requirements

Pathology report confirming carcinoma in situ must be included.

Specialty Considerations

Oncologists should ensure that the excision is documented as part of the treatment plan.

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. D05.90 reflects the need for precise documentation to avoid ambiguity in treatment and management.

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. D05.90 reflects the need for precise documentation to avoid ambiguity in treatment and management.

Reimbursement & Billing Impact

reimbursement processes. D05.90 reflects the need for precise documentation to avoid ambiguity in treatment and management.

Resources

Clinical References

  • •
    American Cancer Society - Breast Cancer

Coding & Billing References

  • •
    American Cancer Society - Breast Cancer

Frequently Asked Questions

What does carcinoma in situ mean?

Carcinoma in situ refers to abnormal cells that are confined to their original location and have not invaded surrounding tissues. It is considered a non-invasive form of cancer.

How is carcinoma in situ treated?

Treatment options for carcinoma in situ may include surgery, radiation therapy, and close monitoring. The choice of treatment depends on the specific type and characteristics of the carcinoma.