2025 ICD-10-CM code C50.919
(Active) Effective Date: N/A Neoplasms - Malignant neoplasm of breast 2: Neoplasms Feed
Malignant neoplasm of unspecified site of unspecified female breast.
Medical necessity must be established for all services related to the diagnosis and treatment of malignant breast neoplasms. This includes appropriate documentation of the patient's symptoms, diagnostic workup, and treatment plan, all consistent with established guidelines for breast cancer care.
A female patient with malignant neoplasm of the breast typically presents with a lump or mass in the breast, possibly accompanied by pain, changes in breast size or shape, dimpling of the skin, tenderness, nipple retraction, or discharge. Diagnosis involves physical examination, biopsy, and imaging studies (mammogram, ultrasound, MRI, PET scan). Treatment varies based on stage and location, ranging from lumpectomy or mastectomy to chemotherapy, radiation, and targeted therapies.
In simple words: This code represents breast cancer in a female patient where the exact location in the breast isn't specified.
Malignant neoplasm of the breast in a female patient refers to the abnormal growth of breast cells that can spread rapidly to nearby tissues, blood vessels, or lymphatic vessels. This code is used when the documentation does not specify the site of the breast nor specifies right or left breast.
Example 1: A female patient presents with a palpable lump in her breast, but the physician's documentation does not specify the location within the breast (e.g., upper outer quadrant). After diagnostic workup, including biopsy, confirms malignancy, C50.919 is used., A female patient undergoes a routine mammogram, which reveals a suspicious mass. The radiologist's report does not pinpoint the exact location, and subsequent biopsy confirms malignancy. In this case, C50.919 would be appropriate until further specification is available., A female patient with a history of breast cancer presents with generalized breast pain. Examination and imaging reveal recurrence, but without a precisely defined location within the breast. C50.919 is used to code the recurrence until further details are determined.
Documentation should include details of the patient's presentation, physical examination findings, imaging results, biopsy results confirming malignancy, and any additional relevant clinical information, such as estrogen receptor status. Although the specific site might not be documented initially, every effort should be made to obtain more precise location information for accurate coding.
** For cases where the site of the breast (right or left) is specified, more specific codes within the C50 category should be used. If further details regarding the location within the breast are available (e.g., nipple, central portion, upper-inner quadrant), even more specific codes can be applied.
- Payment Status: Active
- Specialties:Oncology, Surgery, Radiology, Pathology
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Independent Clinic, Federally Qualified Health Center