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v1.0.0
ICD-10 Guide
ICD-10 CodesC16.1

C16.1

Billable

Malignant neoplasm of fundus of stomach

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

Code Description

ICD-10 C16.1 is a billable code used to indicate a diagnosis of malignant neoplasm of fundus of stomach.

Key Diagnostic Point:

C16.1 refers to a malignant neoplasm located specifically in the fundus of the stomach, which is the uppermost part of the stomach. Gastric cancer, particularly in this region, is often associated with chronic infection by Helicobacter pylori (H. pylori), a bacterium that can lead to chronic gastritis and is a significant risk factor for the development of gastric adenocarcinoma. The pathophysiology involves the transformation of gastric epithelial cells due to prolonged inflammation and genetic mutations. Staging of gastric cancer is crucial for determining treatment options and prognosis, typically classified using the TNM system (Tumor, Node, Metastasis). Treatment often involves surgical intervention, such as gastrectomy, which may be partial or total depending on the extent of the disease. Postoperative care and monitoring for recurrence are essential components of management. Accurate coding for C16.1 requires thorough documentation of the diagnosis, staging, and any surgical procedures performed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between various types of gastric neoplasms
  • Staging requirements and documentation
  • Association with H. pylori and its treatment implications
  • Variability in surgical procedures (partial vs. total gastrectomy)

Audit Risk Factors

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

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Diagnosis of gastric cancer, staging evaluations, and treatment planning.

Billing Considerations

Ensure accurate documentation of tumor characteristics and treatment response.

Gastroenterology

Documentation Requirements

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

Common Clinical Scenarios

Management of gastric ulcers, chronic gastritis, and screening for gastric cancer.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use C16.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the diagnosis, staging, and any associated conditions
  • Include details on the type of neoplasm and any relevant treatment history

Exclusion Criteria

Do NOT use C16.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

43631CPT Code

Laparoscopic total gastrectomy

Clinical Scenario

Used for patients diagnosed with malignant neoplasm of the fundus of the stomach.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Oncology and surgery specialties must coordinate documentation.

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 research and treatment outcomes. C16.1 provides a clear distinction for malignant neoplasms of the fundus, aiding in better tracking and management of gastric cancer cases.

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 research and treatment outcomes. C16.1 provides a clear distinction for malignant neoplasms of the fundus, aiding in better tracking and management of gastric cancer cases.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of gastric cancers, improving the granularity of data for research and treatment outcomes. C16.1 provides a clear distinction for malignant neoplasms of the fundus, aiding in better tracking and management of gastric cancer cases.

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, particularly adenocarcinoma. It causes chronic inflammation and can lead to changes in the gastric epithelium, increasing the risk of malignant transformation.