C50.019

Billable

Malignant neoplasm of nipple and areola, unspecified female breast

HCC Category Mapping

V28HCC 23 — Melanoma and Other Skin Cancers

0.251

V24HCC 12 — Breast, Prostate, and Other Cancers and Tumors

0.150

ESRDHCC 12 — Breast, Prostate, and Other Cancers and Tumors

0.000

RxHCCHCC 22 — Cancer, Other Specified Sites

0.000

What This Code Means

Breast cancer that starts in the nipple or areola on a female breast, but the specific side (left or right) is not documented.

Coding Tips

•Use this code only when laterality cannot be determined from the medical record
•Query the provider to obtain laterality information, as unilateral codes (C50.011 or C50.012) are preferred

Clinical Significance

Malignant neoplasm of the nipple and areola, unspecified female breast represents invasive breast cancer requiring staging, treatment planning, and ongoing surveillance. Breast cancer is risk-adjusted because it demands significant healthcare resources including surgery, radiation, chemotherapy, hormonal therapy, and long-term monitoring. The unspecified laterality indicates documentation does not identify the affected side, which should trigger a provider query.

Documentation Requirements

✓Pathologic confirmation of malignancy — distinguish Paget disease of nipple from invasive carcinoma with nipple involvement
✓Laterality must be queried if not documented — right or left breast
✓Gender documented as female to support gender-specific code selection
✓Quadrant or subsite location: nipple and areola
✓Tumor size (T stage) and grade
✓Lymph node status (N stage) — axillary, sentinel node biopsy results
✓Estrogen receptor, progesterone receptor, and HER2 status
✓Stage grouping (I-IV)
✓Current treatment status (active treatment, hormonal therapy, surveillance)

Commonly Confused Codes

C50.011 — Right female breast nipple/areola; preferred when right side documented C50.012 — Left female breast nipple/areola; preferred when left side documented C50.029 — Same laterality but male breast; verify patient gender C50.111-C50.119 — Central portion of female breast; central portion is distinct from nipple/areola D05.x — Carcinoma in situ of breast; must distinguish invasive from in situ disease

Code Hierarchy

└C50Malignant neoplasm of breast └C50.0Malignant neoplasm of nipple and areola └C50.01Malignant neoplasm of nipple and areola, female └C50.019Malignant neoplasm of nipple and areola, unspecified female breast

└C50.019Malignant neoplasm of nipple and areola, unspecified female breast