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v1.0.0
ICD-10 Guide
ICD-10 CodesC16.3

C16.3

Billable

Malignant neoplasm of pyloric antrum

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

Code Description

ICD-10 C16.3 is a billable code used to indicate a diagnosis of malignant neoplasm of pyloric antrum.

Key Diagnostic Point:

C16.3 refers to a malignant neoplasm located in the pyloric antrum, which is the lower portion of the stomach that connects to the duodenum. Gastric cancer, particularly in this region, is often associated with chronic infection by Helicobacter pylori (H. pylori), a bacterium that can lead to inflammation and changes in gastric mucosa, increasing the risk of cancer development. The clinical presentation may include symptoms such as abdominal pain, weight loss, nausea, and vomiting. Diagnosis typically involves endoscopy with biopsy, imaging studies, and staging to determine the extent of disease spread. Staging is crucial as it guides treatment options, which may include surgical resection (gastrectomy), chemotherapy, and radiation therapy. The prognosis for patients with C16.3 can vary significantly based on the stage at diagnosis, with early-stage cancers having a better outcome compared to advanced disease.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between gastric cancer types and stages
  • Understanding the relationship with H. pylori infection
  • Navigating surgical and non-surgical treatment options
  • Interpreting pathology reports for accurate staging

Audit Risk Factors

  • Inadequate documentation of staging
  • Failure to document H. pylori status
  • Misclassification of tumor type
  • Lack of clarity in surgical procedure documentation

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Patients presenting with symptoms of gastric cancer, undergoing staging and treatment.

Billing Considerations

Ensure accurate staging and documentation of H. pylori status.

Gastroenterology

Documentation Requirements

Endoscopy reports, biopsy results, and follow-up care notes.

Common Clinical Scenarios

Patients with dyspepsia or gastrointestinal bleeding undergoing evaluation for gastric cancer.

Billing Considerations

Document any findings related to H. pylori and gastric mucosal changes.

Coding Guidelines

Inclusion Criteria

Use C16.3 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the diagnosis, staging, and any associated conditions
  • Include details on H
  • pylori status and treatment plans

Exclusion Criteria

Do NOT use C16.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

43620CPT Code

Laparoscopic gastric bypass

Clinical Scenario

Used in cases of obesity with concurrent gastric cancer.

Documentation Requirements

Document indications for surgery and any findings during the procedure.

Specialty Considerations

Ensure coordination between oncology and bariatric specialties.

43191CPT Code

Gastrectomy, total

Clinical Scenario

Performed for C16.3 with curative intent.

Documentation Requirements

Detailed operative report and pathology findings.

Specialty Considerations

Oncology and surgical documentation must align.

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, including C16.3, which enhances data accuracy and improves patient care tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of gastric cancers, including C16.3, which enhances data accuracy and improves patient care tracking.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of gastric cancers, including C16.3, which enhances data accuracy and improves patient care tracking.

Resources

Clinical References

  • •
    American Cancer Society - Gastric Cancer
  • •
    National Cancer Institute - Stomach Cancer Treatment

Coding & Billing References

  • •
    American Cancer Society - Gastric Cancer
  • •
    National Cancer Institute - Stomach Cancer Treatment

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 in the development of chronic gastritis and subsequent malignant transformation of gastric mucosa.

How is C16.3 staged?

Staging for C16.3 involves imaging studies, endoscopic evaluation, and biopsy results to determine the extent of tumor spread, which is crucial for treatment planning.