C50.419
BillableMalignant neoplasm of upper-outer quadrant of unspecified female breast
HCC Category Mapping
V28HCC 23 — Melanoma and Other Skin Cancers
0.251V24HCC 12 — Breast, Prostate, and Other Cancers and Tumors
0.150ESRDHCC 12 — Breast, Prostate, and Other Cancers and Tumors
0.000RxHCCHCC 22 — Cancer, Other Specified Sites
0.000What This Code Means
Cancer in the upper-outer area of the breast in women when the specific side (left or right) is not documented or known.
Coding Tips
- •Use this code only when laterality cannot be determined from documentation
- •Query the provider if laterality information is available elsewhere in the medical record
Clinical Significance
Malignant neoplasm of the upper-outer quadrant of 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 invasive malignancy (biopsy with histologic type — ductal, lobular, etc.)
- ✓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: upper-outer quadrant
- ✓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
C50.411 — Right female; preferred when right documentedC50.412 — Left female; preferred when left documentedC50.429 — Same laterality but male breast; verify patient genderC50.211-C50.219 — Upper-inner quadrant; most common confusion — upper-outer is lateral (toward axilla), upper-inner is medial (toward sternum)C50.511-C50.519 — Lower-outer quadrant; same lateral orientation but lower positionC50.811-C50.819 — Overlapping sites; use when tumor spans multiple quadrants
Code Hierarchy
└C50Malignant neoplasm of breast└C50.4Malignant neoplasm of upper-outer quadrant of breast└C50.41Malignant neoplasm of upper-outer quadrant of breast, female└C50.419Malignant neoplasm of upper-outer quadrant of unspecified female breast
└C50.419Malignant neoplasm of upper-outer quadrant of unspecified female breast