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v1.0.0
ICD-10 Guide
ICD-10 CodesC16.0

C16.0

Billable

Malignant neoplasm of cardia

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 C16.0 is a billable code used to indicate a diagnosis of malignant neoplasm of cardia.

Key Diagnostic Point:

C16.0 refers to malignant neoplasms located at the cardia, which is the region where the esophagus meets the stomach. This type of gastric cancer is often associated with chronic infection by Helicobacter pylori (H. pylori), a bacterium that can lead to gastric inflammation and is a known risk factor for gastric malignancies. The clinical presentation may include symptoms such as dysphagia, weight loss, and abdominal pain. Diagnosis typically involves endoscopy and biopsy, with histological examination confirming malignancy. Staging of gastric cancer is crucial for treatment planning and is based on the TNM classification system, which assesses tumor size (T), lymph node involvement (N), and the presence of metastasis (M). Treatment options may include surgical resection, such as gastrectomy, chemotherapy, and radiation therapy, depending on the stage of the disease. Accurate coding is essential for appropriate reimbursement and tracking of cancer treatment outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in staging and treatment options
  • Need for precise documentation of tumor location and extent
  • Differentiation from benign gastric conditions
  • Association with H. pylori and its implications for treatment

Audit Risk Factors

  • Inadequate documentation of staging
  • Failure to document H. pylori status
  • Misclassification of tumor type
  • Incomplete surgical documentation post-gastrectomy

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, staging information, and treatment plans.

Common Clinical Scenarios

Patients presenting with symptoms of gastric cancer, undergoing chemotherapy or surgical interventions.

Billing Considerations

Ensure accurate staging and documentation of treatment response.

Gastroenterology

Documentation Requirements

Endoscopy reports, biopsy results, and H. pylori testing.

Common Clinical Scenarios

Patients with dyspepsia or gastrointestinal bleeding undergoing diagnostic procedures.

Billing Considerations

Document any findings related to H. pylori and its treatment.

Coding Guidelines

Inclusion Criteria

Use C16.0 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the tumor's location, staging, and any associated conditions
  • Include details about H
  • pylori status and treatment

Exclusion Criteria

Do NOT use C16.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

43631CPT Code

Laparoscopic total gastrectomy

Clinical Scenario

Used for patients with malignant neoplasm of the cardia requiring surgical intervention.

Documentation Requirements

Operative reports detailing the procedure and findings.

Specialty Considerations

Oncology and surgery documentation must align for accurate coding.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of gastric cancers, improving the granularity of data for treatment outcomes and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of gastric cancers, improving the granularity of data for treatment outcomes and research.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of gastric cancers, improving the granularity of data for treatment outcomes and research.

Resources

Clinical References

  • •
    American Cancer Society - Gastric Cancer

Coding & Billing References

  • •
    American Cancer Society - Gastric Cancer

Frequently Asked Questions

What is the significance of H. pylori in gastric cancer?

H. pylori infection is a major risk factor for gastric cancer, leading to chronic inflammation and increasing the likelihood of malignant transformation.