Q.1: BREAST

For Cases Diagnosed prior to January 1, 2003

C50.0-C50.9
SURGICAL APPROACH

 

Code

Description

0

None; no cancer-directed surgery of primary site

4

Open approach, NOS

5

 

Without dye or needle localization

6

 

With dye or needle localization

9

Death certificate only

 

SURGERY OF PRIMARY SITE

 

Code

Description

00

None; no cancer-directed surgery of primary site

Procedures coded as 10-17 remove the gross primary tumor and some of the breast tissue (breast conserving or preserving). There may be microscopic residual tumor.

10

Partial mastectomy, NOS; less than total mastectomy, NOS

11

  

Nipple resection

12

  

Lumpectomy or excisional biopsy

13

  

Reexcision of the biopsy site

Note: Usually for gross or microscopic residual disease

14

  

Wedge resection

15

  

Quadrantectomy

16

  

Segmental mastectomy

17

  

Tylectomy

30

Subcutaneous mastectomy

Note: A subcutaneous mastectomy is the removal of breast tissue without the nipple and areolar complex or overlying skin. This procedure is rarely performed to treat malignancies.

40

Total (simple) mastectomy, NOS

41

  

Without removal of uninvolved contralateral breast

42

  

With removal of uninvolved contralateral breast

Note: A simple mastectomy removes all breast tissue, the nipple, and areolar complex. An axillary dissection is not done. For single primaries only, code removal of involved contralateral breast under the data item Surgery of Other Regional Site(s), Distant Site(s), or Distant Lymph Node(s).

50

Modified radical mastectomy

51

 

Without removal of uninvolved contralateral breast

52

 

With removal of uninvolved contralateral breast

Note: Removes all breast tissue, the nipple, the areolar complex, and variable amounts of breast skin. The procedure involves an en bloc resection of the axilla. The specimen may or may not include a portion of the pectoralis major muscle. Includes an en bloc axillary dissection. For single primaries only, code removal of involved contralateral breast under the data item Surgery of Other Regional Site(s), Distant Site(s), or Distant Lymph Node(s).

60

Radical mastectomy, NOS

61

 

Without removal of uninvolved contralateral breast

62

 

With removal of uninvolved contralateral breast

Note: Removal of breast tissue, nipple, areolar complex, a variable amount of skin, pectoralis minor, and pectoralis major. Includes an en bloc axillary dissection. For single primaries only, code removal of involved contralateral breast under the data item Surgery of Other Regional Site(s), Distant Site(s), or Distant Lymph Node(s).

70

Extended radical mastectomy

71

 

Without removal of uninvolved contralateral breast

72

 

With removal of uninvolved contralateral breast

Note: Removal of breast tissue, nipple, areolar complex, variable amounts of skin, pectoralis minor, and pectoralis major. Includes removal of internal mammary nodes and an en bloc axillary dissection. For single primaries only, code removal of involved contralateral breast under the data item Surgery of Other Regional Site(s), Distant Site(s), or Distant Lymph Node(s).

80

Mastectomy, NOS

90

Surgery, NOS

99

Unknown if cancer-directed surgery performed; death certificate only

 

SURGICAL MARGINS

Since the codes are hierarchical, if more than one code is applicable, use the numerically higher code. For example, if multiple margins are microscopically and macroscopically involved, code the macroscopic involvement(s).

Multiple margins are two separate margins, both of which are microscopically involved with tumor. Do not code multiple margins (4) if one margin has multiple foci of tumor.

 

Code

Description

0

All margins grossly and microscopically negative

1

Margins involved, NOS

2

 

Microscopic involvement

3

 

 

Single margin

4

 

 

Multiple margins

5

 

Macroscopic involvement

7

Margins not documented

8

No cancer-directed surgery of primary site

9

Unknown whether margins were involved or negative; death certificate only

 

SCOPE OF REGIONAL LYMPH NODE SURGERY

 

Code

Description

0

No regional lymph nodes removed

1

Sentinel lymph nodes removed

Note: A sentinel node is the first node to receive drainage from a primary tumor. It is identified by an injection of a dye or radio label at the site of the primary tumor.

2

Regional lymph nodes removed, NOS; axillary, NOS (Levels I, II, or III lymph nodes) Intramammary, NOS

3

  

Combination of 1 and 2

4

  

Internal mammary

5

  

Combination of 4 with any of 1-3

9

Unknown; not stated; death certificate only

 

NUMBER OF REGIONAL LYMPH NODES EXAMINED

 

Code

Description

00

No regional lymph nodes removed

01

One regional lymph node removed

02

Two regional lymph nodes removed

..

 

90

Ninety or more regional lymph nodes removed

95

No regional lymph nodes removed but aspiration of regional lymph nodes was performed

96

Regional lymph node removal documented as a sampling and number of lymph nodes unknown/not stated

97

Regional lymph node removal documented as dissection and number of lymph nodes unknown/not stated

98

Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not documented as sampling or dissection

99

Unknown; not stated; death certificate only

 

SURGERY OF OTHER REGIONAL SITE(S), DISTANT SITE(S) OR DISTANT LYMPH NODE(S)

Do not code removal of fragments or tags of muscles; removal of the pectoralis minor; the resection of pectoralis muscles, NOS; or the resection of fascia with no mention of muscle.

 

Code

Description

0

None; no surgery to other regional or distant sites

1

Surgery to other sites or nodes, NOS; unknown if regional or distant

2

 

Other regional sites

3

 

Distant lymph nodes

4

 

Distant sites

5

 

 

Removal of involved contralateral breast (single primary only)

6

 

Combination of 4 or 5 with 2 or 3

9

Unknown whether margins were involved or negative; death certificate only

 

RECONSTRUCTION/RESTORATION - FIRST COURSE

The insertion of a tissue expander is often the beginning of the reconstructive procedure.

 

Code

Description

0

No reconstruction/restoration

1

Reconstruction, NOS (unknown if flap)

2

 

Implant; reconstruction without flap

3

 

Reconstruction with flap, NOS

4

 

  

Latissimus dorsi flap

5

 

  

Abdominus recti flap

6

 

  

Flap, NOS + implant

7

 

  

Latissimus dorsi flap + implant

8

 

 

Abdominus recti + implant

9

Unknown; not stated; death certificate only

 

 

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