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Question: Our pathologist diagnosed inflammatory breast cancer. Should we report this using N61 instead of one of the usual codes we use for more common breast cancers, such as invasive ductal carcinoma (IDC) or ductal carcinoma in situ (DCIS)?

Arizona Subscriber

Answer: No, you would not use a genitourinary system code from N61.- (Inflammatory disorders of breast) for a confirmed diagnosis of inflammatory breast cancer.

Why? Code N61 provides an 鈥淓xcludes 1鈥� note for inflammatory carcinoma of breast, referring you instead to C50.9- (Malignant neoplasm of breast of unspecified site). This tells you inflammatory breast cancer should be reported using a neoplasm code.

So, instead of N61.-, you should begin by looking to the C50.- (Malignant neoplasm of breast) code family, coding to the 6^th character for the highest level of specificity. That means using a 4^th character to identify the specific breast site such as nipple and areola (0), central portion (1), various quadrants (2 through 5), axillary tail (6), overlapping sites (8), and unspecified site (9). The 5^th character indicates female (1) or male (2) breast, while the 6^th character indicates either an unspecified breast (9) or breast laterality, with 1 being for the right breast and 2 for the left. Other malignant breast neoplasms that report to the C50 family include IDC and invasive lobular carcinoma (ILC).

Distinguish in situ: You should not use the C50.- family for other abnormal cells found in the breast, such as DCIS or lobular carcinoma in situ (LCIS). For these conditions, you will turn to the D05.- family (Carcinoma in situ of breast), using D05.0- (Lobular carcinoma in situ of breast) for LCIS and D05.1- (Intraductal carcinoma in situ of breast) for DCIS. For the highest level of specificity for these codes, you鈥檒l need to report 5^th characters to indicate unspecified breast (0), right breast (1), or left breast (2).

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC