ICD-10 Coding for Brain Metastasis(C79.31, C80.1)
Complete ICD-10-CM coding and documentation guide for Brain Metastasis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Brain Metastasis
C79.31Primary Range
Secondary malignant neoplasm of brain
Primary code for confirmed brain metastasis from another primary cancer.
Malignant neoplasm of brain
Used when primary brain cancer is suspected or confirmed, not for metastasis.
Malignant neoplasm without specification of site
Used when the primary site of the cancer is unknown.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C79.31 | Secondary malignant neoplasm of brain | Use when brain metastasis is confirmed from another primary cancer. |
|
| C80.1 | Malignant neoplasm without specification of site | Use when the primary site of cancer is unknown. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for brain metastasis
Essential facts and insights about Brain Metastasis
Primary ICD-10-CM Codes for brain metastasis
Decision Criteria
clinical Criteria
- Presence of brain lesions on imaging with known primary cancer
documentation Criteria
- Explicit mention of metastasis from a primary site
Applicable To
- Metastatic brain cancer
Excludes
- Primary brain cancer (C71.9)
Clinical Validation Requirements
- Imaging (MRI/CT) showing brain lesions
- Biopsy confirming metastatic cancer cells
Code-Specific Risks
- Incorrectly coding as primary brain cancer
- Missing documentation of primary cancer site
Coding Notes
- Ensure documentation specifies the metastatic nature and primary site if known.
C80.1 - Malignant neoplasm without specification of site
Use when the primary site of cancer is unknown.
Applicable To
- Cancer of unknown primary
Excludes
- Specified primary cancer sites
Clinical Validation Requirements
- Exhaustive workup failing to identify primary site
Coding Notes
Use in conjunction with C79.31 when primary site is unknown.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other specified disorders of brain
G93.89Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Malignant neoplasm of brain, unspecified
C71.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Brain Metastasis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C79.31.
Impact
Clinical: Misrepresentation of active disease status., Regulatory: Non-compliance with coding guidelines., Financial: Potential under-coding affecting reimbursement.
Mitigation Strategy
Review active treatment status, Avoid 'history of' unless primary is eradicated
Impact
Reimbursement: Incorrect DRG assignment leading to reimbursement errors., Compliance: Potential for audit and compliance issues., Data Quality: Inaccurate clinical data affecting patient care.
Mitigation Strategy
Ensure documentation specifies metastasis and primary site if known.
Impact
Using brain metastasis as principal diagnosis when a complication is the reason for admission.
Mitigation Strategy
Ensure documentation reflects the true reason for admission.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Brain Metastasis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Brain Metastasis
Use these documentation templates to ensure complete and accurate documentation for Brain Metastasis. These templates include all required elements for proper coding and billing.
Neurology Consult for Brain Metastasis
Specialty: NeurologyRequired Elements
- Imaging findings
- Primary cancer linkage
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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