ICD-10 Coding for Cancer Antigen 19-9(C25.9, R97.2)
Complete ICD-10-CM coding and documentation guide for Cancer Antigen 19-9. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Cancer Antigen 19-9
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C25.9 | Malignant neoplasm of pancreas, unspecified | Use when CA 19-9 is elevated in the context of confirmed pancreatic cancer. |
|
| R97.2 | Elevated tumor marker | Use when CA 19-9 is elevated but no malignancy is confirmed. |
|
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 cancer antigen 19-9
Essential facts and insights about Cancer Antigen 19-9
Primary ICD-10-CM Codes for cancer antigen 19-9
Decision Criteria
clinical Criteria
- Confirmed pancreatic cancer with elevated CA 19-9
Applicable To
- Pancreatic cancer
Excludes
- Benign neoplasm of pancreas
Clinical Validation Requirements
- Biopsy-confirmed pancreatic cancer
- Elevated CA 19-9 levels >37 U/mL
Code-Specific Risks
- Misclassification if used without confirmed malignancy
Coding Notes
- Ensure documentation includes imaging and biopsy results.
R97.2 - Elevated tumor marker
Use when CA 19-9 is elevated but no malignancy is confirmed.
Applicable To
- Elevated CA 19-9
Excludes
- Normal tumor marker levels
Clinical Validation Requirements
- CA 19-9 level >37 U/mL without confirmed malignancy
Coding Notes
Document clinical rationale for testing.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Cancer Antigen 19-9 to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C25.9.
Impact
Clinical: May lead to inappropriate testing., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Always include a clinical rationale in the patient's record.
Impact
Reimbursement: Claims may be denied due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of patient condition.
Mitigation Strategy
Always pair with a primary malignancy code like C25.9.
Impact
Lack of detailed clinical context can trigger audits.
Mitigation Strategy
Ensure comprehensive documentation of clinical indications and test results.
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 Cancer Antigen 19-9, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Cancer Antigen 19-9
Use these documentation templates to ensure complete and accurate documentation for Cancer Antigen 19-9. These templates include all required elements for proper coding and billing.
Monitoring pancreatic cancer
Specialty: OncologyRequired Elements
- Patient history
- CA 19-9 levels
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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