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ICD-10 Guide
ICD-10 CodesD05.92

D05.92

Billable

Unspecified type of carcinoma in situ of left breast

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

Code Description

ICD-10 D05.92 is a billable code used to indicate a diagnosis of unspecified type of carcinoma in situ of left 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 confined to their original location. The unspecified type indicates that the specific histological subtype of carcinoma in situ has not been determined. Common types of breast carcinoma in situ include ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). Patients diagnosed with D05.92 may undergo various surveillance protocols, including regular mammograms and clinical breast exams, to monitor for any signs of 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 risk include tumor size, grade, and the presence of necrosis. Early detection and management are crucial in improving outcomes for patients with this diagnosis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in histological subtypes of carcinoma in situ
  • Need for precise documentation of tumor characteristics
  • Potential for misclassification with invasive breast cancer codes
  • Variations in treatment protocols based on subtype

Audit Risk Factors

  • Inadequate documentation of tumor characteristics
  • Failure to specify the laterality of the breast
  • Misalignment between diagnosis and treatment codes
  • Inconsistent follow-up documentation

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Pathology reports must clearly specify the type of carcinoma in situ and any relevant tumor characteristics.

Common Clinical Scenarios

Patients undergoing surgical excision or radiation therapy for DCIS.

Billing Considerations

Ensure that the treatment plan aligns with the documented diagnosis to avoid discrepancies.

Radiology

Documentation Requirements

Radiology reports should detail imaging findings and any recommendations for follow-up imaging.

Common Clinical Scenarios

Routine mammography screenings for patients with a history of carcinoma in situ.

Billing Considerations

Documentation must reflect the need for surveillance imaging based on the patient's risk profile.

Coding Guidelines

Inclusion Criteria

Use D05.92 When
  • According to the ICD
  • CM guidelines, carcinoma in situ codes should be used when there is a definitive diagnosis of carcinoma in situ, and the documentation must support the diagnosis

Exclusion Criteria

Do NOT use D05.92 When
  • Exclusion criteria include any invasive breast cancer diagnosis

Related ICD-10 Codes

Related CPT Codes

19301CPT Code

Mastectomy, partial (lumpectomy)

Clinical Scenario

Used for surgical treatment of DCIS.

Documentation Requirements

Operative reports must detail the procedure performed and the diagnosis.

Specialty Considerations

Oncology specialists should ensure that the diagnosis aligns with the surgical procedure.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding carcinoma in situ, enabling better tracking of patient outcomes and treatment efficacy. D05.92 provides a clear designation for unspecified types of carcinoma in situ, which aids in research and epidemiological studies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding carcinoma in situ, enabling better tracking of patient outcomes and treatment efficacy. D05.92 provides a clear designation for unspecified types of carcinoma in situ, which aids in research and epidemiological studies.

Reimbursement & Billing Impact

reimbursement.

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 significant because it indicates the presence of abnormal cells that have the potential to develop into invasive cancer if left untreated. Early detection and management are crucial for preventing progression.