Version 2024

2024 ICD-10-CM Diagnosis Code D49.3

Neoplasm of unspecified behavior of breast

ICD-10-CM Code:: D49.3
ICD-10 Code for:: Neoplasm of unspecified behavior of breast
Is Billable?: Yes - Valid for Submission
Chronic Condition Indicator: ^[1]: Not chronic
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Code Information
Approximate Synonyms
Clinical Classification
Tabular List of Diseases and Injuries
Diagnostic Related Groups Mapping
Convert to ICD-9 Code
Table of Neoplasms
Patient Education
Other Codes Used Similar Conditions
Code History

Code Classification

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
(D50–D89)
- Neoplasms of unspecified behavior
  (D49)
  - Neoplasms of unspecified behavior
    (D49)

D49.3 is a billable diagnosis code used to specify a medical diagnosis of neoplasm of unspecified behavior of breast. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.

The following anatomical sites found in the Table of Neoplasms reference this diagnosis code given the correct histological behavior: Neoplasm, neoplastic areola ; Neoplasm, neoplastic breast (connective tissue) (glandular tissue) (soft parts) ; Neoplasm, neoplastic breast (connective tissue) (glandular tissue) (soft parts) areola ; Neoplasm, neoplastic breast (connective tissue) (glandular tissue) (soft parts) axillary tail ; Neoplasm, neoplastic breast (connective tissue) (glandular tissue) (soft parts) central portion ; Neoplasm, neoplastic breast (connective tissue) (glandular tissue) (soft parts) inner ; Neoplasm, neoplastic breast (connective tissue) (glandular tissue) (soft parts) lower ; etc

Unspecified diagnosis codes like D49.3 are acceptable when clinical information is unknown or not available about a particular condition. Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient's condition. Specific diagnosis codes should not be used if not supported by the patient's medical record.

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

Neoplasm of areola of female breast
Neoplasm of areola of male breast
Neoplasm of axillary tail of female breast
Neoplasm of breast
Neoplasm of central portion of female breast
Neoplasm of ectopic female breast tissue
Neoplasm of ectopic male breast tissue
Neoplasm of female breast
Neoplasm of lower inner quadrant of female breast
Neoplasm of lower outer quadrant of female breast
Neoplasm of male breast
Neoplasm of nipple of female breast
Neoplasm of nipple of male breast
Neoplasm of upper inner quadrant of female breast
Neoplasm of upper outer quadrant of female breast
Surgical margin involvement by tumor present

Clinical Classification

Clinical Category is Neoplasms of unspecified nature or uncertain behavior
CCSR Category Code: NEO072
Inpatient Default CCSR: Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.
Outpatient Default CCSR: Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.

Tabular List of Diseases and Injuries

The following annotation back-references are applicable to this diagnosis code. The Tabular List of Diseases and Injuries is a list of ICD-10-CM codes, organized "head to toe" into chapters and sections with coding notes and guidance for inclusions, exclusions, descriptions and more.

Type 1 Excludes

neoplasm of unspecified behavior of skin of breast D49.2

D49.3 is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
600	NON-MALIGNANT BREAST DISORDERS WITH CC/MCC	09	1.0255
601	NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC	09	0.6226

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Convert D49.3 to ICD-9-CM

ICD-9-CM Code: 239.3 - Breast neoplasm NOS

Table of Neoplasms

This code is referenced in the table of neoplasms by anatomical site. For each site there are six possible code numbers according to whether the neoplasm in question is malignant, benign, in situ, of uncertain behavior, or of unspecified nature. The description of the neoplasm will often indicate which of the six columns is appropriate.

Where such descriptors are not present, the remainder of the Index should be consulted where guidance is given to the appropriate column for each morphological (histological) variety listed. However, the guidance in the Index can be overridden if one of the descriptors mentioned above is present.

Filter table of neoplasms:

Neoplasm, neoplastic	Malignant Primary	Malignant Secondary	CaInSitu	Benign	Uncertain Behavior	Unspecified Behavior
»Neoplasm, neoplastic »areola	C50.0	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts)	C50.9	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts) »areola	C50.0	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts) »axillary tail	C50.6	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts) »central portion	C50.1	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts) »inner	C50.8	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts) »lower	C50.8	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts) »lower-inner quadrant	C50.3	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts) »lower-outer quadrant	C50.5	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts) »midline	C50.8	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts) »nipple	C50.0	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts) »outer	C50.8	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts) »tail (axillary)	C50.6	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts) »upper	C50.8	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts) »upper-inner quadrant	C50.2	C79.81	D05.	D24.	D48.6	D49.3
»Neoplasm, neoplastic »breast (connective tissue) (glandular tissue) (soft parts) »upper-outer quadrant	C50.4	C79.81	D05.	D24.	D48.6	D49.3

Patient Education

Breast Diseases

Most women experience breast changes at some time. Your age, hormone levels, and medicines you take may cause lumps, bumps, and discharges (fluids that are not breast milk).

If you have a breast lump, pain, discharge or skin irritation, see your health care provider. Minor and serious breast problems have similar symptoms. Although many women fear cancer, most breast problems are not cancer.

Some common breast changes are:

Fibrocystic breast changes - lumpiness, thickening and swelling, often just before a woman's period
Cysts - fluid-filled lumps
Fibroadenomas - solid, round, rubbery lumps that move easily when pushed, occurring most in younger women
Intraductal papillomas - growths similar to warts near the nipple
Blocked milk ducts
Milk production when a woman is not breastfeeding

NIH: National Cancer Institute

[Learn More in MedlinePlus]

Code History

FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.

Footnotes

[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.