C50 — Malignant neoplasms of breast
ICD-10-CM codes C50 cover malignant neoplasms of breast, within neoplasms. The block holds 86 codes across 1 category, of which 57 are billable and 29 are header codes that cannot be submitted on a claim.
Risk adjustment in C50
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 22 Bladder, Colorectal, and Other Cancers
- HCC 23 Prostate, Breast, and Other Cancers and Tumors
What else to watch in C50
- 38 codes are laterality-specific. They come in left and right pairs, and the pair is mutually exclusive on a single site: coding both without a bilateral code is a contradiction a scrubber should catch before the payer does.
- 57 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.