ICD-10 Coding for Pancreatic Tumor(C25.0, C25.1, D13.6)
Complete ICD-10-CM coding and documentation guide for Pancreatic Tumor. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pancreatic Tumor
C25.0-C25.9Primary Range
Malignant neoplasms of the pancreas
This range covers all malignant tumors of the pancreas, categorized by specific location.
Benign neoplasms of the pancreas
This range includes benign tumors of the pancreas, important for distinguishing from malignant cases.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C25.0 | Malignant neoplasm of head of pancreas | Use when imaging and biopsy confirm a malignant tumor in the head of the pancreas. |
|
| C25.1 | Malignant neoplasm of body of pancreas | Use when a malignant tumor is confirmed in the body of the pancreas. |
|
| D13.6 | Benign neoplasm of pancreas | Use when imaging and pathology confirm a benign pancreatic tumor. |
|
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 pancreatic cancer
Essential facts and insights about Pancreatic Tumor
Primary ICD-10-CM Codes for pancreatic tumor
Decision Criteria
clinical Criteria
- Biopsy confirms malignant adenocarcinoma in pancreatic head.
Applicable To
- Cancer of the head of the pancreas
Excludes
- Benign neoplasm of pancreas (D13.6)
Clinical Validation Requirements
- CT/MRI showing hypoenhancing mass in head
- Biopsy: Invasive adenocarcinoma
- CA19-9 > 37 U/mL
Code-Specific Risks
- Incorrectly coding as C25.9 without specifying location
Coding Notes
- Ensure documentation specifies 'head' to avoid unspecified coding.
C25.1 - Malignant neoplasm of body of pancreas
Use when a malignant tumor is confirmed in the body of the pancreas.
Applicable To
- Cancer of the body of the pancreas
Excludes
- Benign neoplasm of pancreas (D13.6)
Clinical Validation Requirements
- Mass in pancreatic body confirmed by imaging
- Biopsy: Adenocarcinoma
Coding Notes
Document specific location to avoid unspecified coding.
D13.6 - Benign neoplasm of pancreas
Use when imaging and pathology confirm a benign pancreatic tumor.
Applicable To
- Benign cystadenoma of pancreas
Excludes
- Malignant neoplasm of pancreas (C25.x)
Clinical Validation Requirements
- MRI shows benign characteristics
- Pathology confirms benign nature
Coding Notes
Ensure documentation supports benign diagnosis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for chemotherapy
Z51.11Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Pancreatic Tumor to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C25.0.
Impact
Clinical: May lead to inappropriate treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Use specific terms like 'adenocarcinoma of pancreatic head'.
Impact
Reimbursement: Incorrect coding can lead to lower reimbursement rates., Compliance: May result in non-compliance with coding standards., Data Quality: Affects the accuracy of clinical data.
Mitigation Strategy
Specify and code the exact location, such as C25.0 for head.
Impact
Using unspecified codes when specific location is documented.
Mitigation Strategy
Ensure documentation supports specific code selection.
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 Pancreatic Tumor, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pancreatic Tumor
Use these documentation templates to ensure complete and accurate documentation for Pancreatic Tumor. These templates include all required elements for proper coding and billing.
Surgical Resection of Pancreatic Tumor
Specialty: SurgeryRequired Elements
- Preoperative diagnosis
- Operative findings
- Specimens sent
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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