Is D05.1 a billable ICD-10-CM code?

No. D05.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does D05.1 sit in the tabular list?

Neoplasms (C00-D49), in the block In situ neoplasms (D00-D09).

What cannot be coded together with D05.1?

D05.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above D05.1 (D05) and apply to it just the same.

D05.1

D05.1 — Intraductal carcinoma in situ of breast

Non-billable headerICD-10-CM

D05.1 is a non-billable header ICD-10-CM code for intraductal carcinoma in situ of breast. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 inherited from the categories above D05.1

These are not written on D05.1, but they bind it: a note on a category applies to every code beneath it. Billing D05.1 with anything listed here is a denial.

Written on D05 — Carcinoma in situ of breast

carcinoma in situ of skin of breast (D04.5)
melanoma in situ of breast (skin) (D03.5)
Paget's disease of breast or nipple (C50.-)

Excludes2 inherited from the categories above D05.1

Also inherited, and the opposite of Excludes1: these conditions are not part of D05.1, but a patient can have both, so you may code both.

Written on D05 — Carcinoma in situ of breast

malignant neoplasm of breast (C50.-)

Risk adjustment

D05.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code history

D05.1 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead D05.1

3 child codes. Green means billable.

Related codes at this level

Codes that share D05. If D05.1 is not quite right, the correct code is usually one of these.

Questions about D05.1

Is D05.1 a billable ICD-10-CM code?: No. D05.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does D05.1 sit in the tabular list?: Neoplasms (C00-D49), in the block In situ neoplasms (D00-D09).
What cannot be coded together with D05.1?: D05.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above D05.1 (D05) and apply to it just the same.