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Keywords Breast cancer, Documenting and Coding Breast Cancer, C50 Malignant neoplasm of breast, 77067 - Screening mammography

Date posted: Tuesday, September 14, 2021

Category: Coding

Cancer arises when specific changes (called mutations) occur in the genes that regulate cell growth, causing the cells to divide and multiply in an uncontrolled way. There are more than 100 types of cancer, and the most common types are breast cancer, skin cancer, lung cancer, and colon cancer, among others. Breast cancer is by far the most commonly occurring cancer and the second most fatal cancer in women. With an objective to generate widespread global awareness of breast cancer, the month of October is observed as “National Breast Cancer Awareness Month (NBCAM)” in the United States every year. Sponsored by the American Cancer Society (ACS), the primary goal behind this observance is to involve as many people as possible in spreading awareness about breast cancer and generating funds to help support life-saving cancer research. 

Aprominent cause of premature mortality among women, breast cancer develops in the breast cells. The cells that grow or multiply in an uncontrolled way often tend to invade other healthy breast tissues and travel to the lymph nodes under the arms. The lymph nodes are a primary pathway that helps the cancer cells move to other parts of the body. The 2021 month-long observance aims to respect the resilience of breast cancer survivors and offer heartfelt support to those who are currently battling with this disease. It aims to encourage women to discuss with their physicians and identify their individual risks for breast cancer.

Even though most breast cancers occur entirely in women, men can also get breast cancer. Most breast lumps that occur are benign and non-cancerous (malignant). Non-cancerous tumors do not spread outside the breast and hence are not life-threatening. However, certain types of benign breast lumps can increase a woman's risk of getting breast cancer. 

Hence, any specific changes or lumps that appear in the breast tissue need to be immediately checked by a healthcare professional to verify whether it is benign or malignant (cancer) and whether it increases future cancer risk. The month-long NBCAM campaign has garnered significant support for breast cancer awareness and research funding, and thereby created advances in the diagnosis and treatment of breast cancer. These support and awareness initiatives have also brought about substantial increases in breast cancer survival rates, while the death rates associated with the condition have steadily declined. This is largely due to important factors, like early detection, new and personalized approach to treatment, and better knowledge about all aspects of the disease. 

According to the World Health Organization (WHO), breast cancer is the most common cancer globally (as of 2021), accounting for 12 percent of all new annual cancer cases worldwide. In 2021, breast cancer has become the most diagnosed cancer among American women-with about 30 percent of newly diagnosed cancers in women being breast cancers. In fact, breast cancer death rates in U.S. women are higher than those for any other cancer, besides lung cancer. 

In most cases, abnormal growth of breast cells is the most common cause of breast cancer. When compared to healthy cells, these abnormal cells divide more rapidly, forming a lump or mass. Over time, these cells may spread (metastasize) through the breast tissue toward the lymph nodes or to other parts of the body. Researchers have identified several factors, such as being female, increasing age, a personal/family history of breast cancer or breast conditions, obesity, hormonal imbalances, radiation exposure, late pregnancy, inherited gene mutations, and other lifestyle and environmental factors that tend to increase the chance of developing this type of cancer.

It is estimated that a woman's risk factor of breast cancer nearly doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with the same condition. In fact, less than 15 percent of women who get diagnosed with this condition have a relative family member diagnosed with the same condition. On the other hand, nearly 5-10 percent of breast cancers can be linked to known gene mutations inherited from one's mother or father. In several other cases, many women develop this type of cancer without any known risk factors other than simply being women. 

Breast cancers are divided into different categories: “invasive” and “non-invasive” or “in situ.” Invasive type of cancer tends to spread from the breast ducts or glands to other parts of the breast, whereas non-invasive cancer does not spread from the original tissue. 

There are different stages of breast cancer, which can be determined based on the size of the tumor and how much it has spread to other tissues or organs. Tumors that are relatively large or have severely spread to nearby tissues or organs are considered as "high stage or last stage." 

Stage 0 - Stage 0 is DCIS - wherein the cancer cells remain in the ducts in the breast and have not spread to nearby tissues. 

Stage 1 - This is further divided into two different categories - 

Stage 2 - Stage 2 is classified into two different categories - 

Stage 3 - Stage 3 breast cancer is divided into three different categories - 

Stage 4 - At this stage, the tumor can be of any specific size and the cancer cells may have spread to nearby lymph nodes, as well as to other nearby organs.

 

In most cases, breast cancer in its early stages may not cause any specific signs and symptoms as the tumor may be too small to be felt. If a tumor can be felt, such as a new lump in the breast, it is one of the initial symptoms of this condition. However, it is not necessary that all lumps are cancerous (as lumps can also be caused by a benign cyst).  

To correctly diagnose whether the symptoms are caused by breast cancer or a benign breast condition, oncologists or other specialists may perform a detailed physical examination, which involves a breast exam and other diagnostic tests or procedures to correctly identify the type and stage of cancer. As part of the breast examination, physicians will check both breasts and lymph nodes in the armpit to identify any specific lumps or other abnormalities. 

Other tests and procedures that are used to diagnose the condition include breast ultrasound (to determine the density of the breast lump), mammogram (an X-ray of the breast), breast magnetic resonance imaging (MRI), and biopsy (removing a sample of breast cells for testing). Considered one of the most definitive ways to make a diagnosis of breast cancer, biopsy involves extracting a core of tissue or sample from the specific breast area. These samples are sent to the laboratory for a detailed analysis to confirm whether the cells are cancerous, and if so, the stage and severity of cancer and whether these cells have hormone receptors or other receptors that may influence future treatment options. 

Several tests and procedures are performed to identify the stage of breast cancer, and these include complete blood count test, breast MRI, mammogram, bone scan, computerized tomography (CT) scan, and positron emission tomography (PET) scan. However, not all women will need to undergo all these tests and procedures; physicians may select the appropriate tests based on the specific symptoms that patients may be experiencing. 

When identified at an early stage, breast cancer treatment can be highly effective, achieving survival probabilities of 90 percent or higher. Treatment modalities for breast cancer will be determined by considering several factors, such as the type of breast cancer, its stage, grade, and size (how likely it is to grow and spread). In addition, the physician will consider the overall health and personal preferences of the patient. In most cases, surgery is the most common treatment for breast cancer. 

Several types of surgery, such as lumpectomy, mastectomy, sentinel node biopsy, axillary lymph node dissection, and contralateral prophylactic mastectomy may be performed to remove the cancerous cells from the breast area. After surgery, patients may have to undergo additional treatments, such as chemotherapy, hormone therapy, or radiation. In certain situations, chemotherapy may also be used before surgery.

As breast cancer is considered a primary cause of premature mortality among U.S. women, recognizing the prominent causes, stages, and symptoms of different types of cancer, and documenting them correctly, is important to ensure accurate coding of the progression of the condition and provide the appropriate care that patients require. Since diagnosing breast cancer at an early stage and receiving state-of-the-art cancer treatment are the most important strategies to reduce cancer morbidity and mortality, breast cancer screening is an important aspect for women's healthcare. 

Undergoing regular screening is the best way to detect the condition when it's in an early stage, before it causes any symptoms (like a lump that can be felt) and has not spread-as this helps in predicting the prognosis (outlook) of a woman with this disease and its successful treatment. 

However, the American Cancer Society (ACS) has set screening guidelines for women who are at average risk of developing breast cancer. To undergo screening, a woman is considered to be at average risk if she doesn't have a personal history of breast cancer, a and has not had chest radiation therapy before the age of 30. 

The diagnostic screening tests and other procedures performed for breast cancer patients need to be correctly documented using the right medical codes. In ICD-10, C-50 is the specific code category for Malignant neoplasm of breast. 

C50 Malignant neoplasm of breast

C50.0 Malignant neoplasm of nipple and areola

C50.01 Malignant neoplasm of nipple and areola, female

C50.2 Malignant neoplasm of upper-inner quadrant of breast

C50.3 Malignant neoplasm of lower-inner quadrant of breast

C50.4 Malignant neoplasm of upper-outer quadrant of breast

C50.5 Malignant neoplasm of lower-outer quadrant of breast

C50.6 Malignant neoplasm of axillary tail of breast

C50.8 Malignant neoplasm of overlapping sites of breast

C50.9 Malignant neoplasm of breast of unspecified site

The month of October serves as a unique reminder for women to get screened regularly for early cancer detection, which in turn will lead to more positive outcomes in the fight against breast cancer. The history of Breast Cancer Awareness campaigns date back to 1985, when the campaign was founded as a partnership between the American Cancer Society and the pharmaceutical division of Imperial Chemical Industries (now part of AstraZeneca, producer of several anti-breast cancer drugs). The campaign was initially planned as a week-long event in the United States in October. Later, it was extended to a month-long awareness observance to promote mammography as the most effective tool in the fight against breast cancer. 

Today, the scope of the campaign has widened with several non-profit organizations, government agencies, and medical societies working together to promote breast cancer awareness. As pink is the official color of the event, people wear pink ribbons to show their support for this campaign. Several other events-like hosting breast cancer walks, displaying posters, and distributing materials about breast cancer screening at local health fairs-will be conducted all over the U.S. Breast cancer patients and survivors will be encouraged to share their personal stories of cancer battles via different social media platforms. 

Even though there are several risk factors that cannot be controlled, incorporating simple but healthy changes in daily life, such as staying physically active, eating a healthy diet, limiting the use of alcohol, undergoing regular breast screenings, and taking preventive measures that physicians recommend, can help reduce the potential risk for developing breast cancer in the long run. 

Join the NBCAM campaign this October. Generate awareness about breast cancer among individuals, communities, and organizations, and emphasize the importance of early breast screenings. 

Meghann Drella, CPC, is a Senior Solutions Manager at Managed Outsource Solutions (MOS), and is responsible for practice and revenue cycle management in the Healthcare Division. She has a formal education in Medical Coding and Billing and over 12 years of hands on experience in the field. She holds a CPC certification with the American Academy of Professional Coders (AAPC). Meghann has a strong understanding of ICD-10-CM and CPT requirements and procedures, and regularly attends continuing education classes to stay up to date with any changes.