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v1.0.0
ICD-10 Guide
ICD-10 CodesC16.9

C16.9

Billable

Malignant neoplasm of stomach, unspecified

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

Code Description

ICD-10 C16.9 is a billable code used to indicate a diagnosis of malignant neoplasm of stomach, unspecified.

Key Diagnostic Point:

C16.9 refers to a malignant neoplasm of the stomach that is unspecified, indicating that the exact location or type of gastric cancer has not been determined. Gastric cancer, or stomach cancer, is a significant health concern globally, often associated with chronic infection by Helicobacter pylori (H. pylori), a bacterium that can lead to chronic gastritis and is a known risk factor for gastric adenocarcinoma. The disease can present at various stages, from localized tumors to advanced disease with metastasis. Staging is crucial for treatment planning and prognosis, typically classified using the TNM system, which assesses tumor size (T), lymph node involvement (N), and distant metastasis (M). Treatment often involves surgical intervention, such as gastrectomy, which may be partial or total, depending on the tumor's extent. Postoperative care and monitoring for recurrence are essential components of management. Accurate coding for gastric cancer is vital for appropriate treatment and reimbursement, necessitating thorough documentation of the diagnosis and staging.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in staging and classification of gastric cancer
  • Need for precise documentation of tumor location and type
  • Association with H. pylori and its implications for treatment
  • Potential for multiple treatment modalities (surgery, chemotherapy, radiation)

Audit Risk Factors

  • Inadequate documentation of staging and tumor characteristics
  • Failure to document H. pylori status
  • Misclassification of gastric cancer type
  • Inconsistent coding of treatment modalities

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans must be documented.

Common Clinical Scenarios

Diagnosis of gastric cancer, staging workup, treatment planning, and follow-up care.

Billing Considerations

Ensure accurate staging and documentation of any metastasis for proper coding.

Gastroenterology

Documentation Requirements

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

Common Clinical Scenarios

Evaluation of gastric symptoms, diagnosis of H. pylori infection, and surveillance for gastric cancer.

Billing Considerations

Document any findings from endoscopic procedures that may indicate malignancy.

Coding Guidelines

Inclusion Criteria

Use C16.9 When
  • According to ICD
  • CM guidelines, C16
  • 9 should be used when the specific site of the malignant neoplasm of the stomach is not documented
  • Coders should ensure that all relevant clinical information is captured to avoid unspecified coding

Exclusion Criteria

Do NOT use C16.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

43631CPT Code

Laparoscopic total gastrectomy

Clinical Scenario

Used for patients diagnosed with gastric cancer requiring surgical intervention.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Oncology and surgery specialties must coordinate documentation 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 and research. However, the use of unspecified codes like C16.9 can lead to challenges in data analysis and treatment planning.

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 and research. However, the use of unspecified codes like C16.9 can lead to challenges in data analysis and treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of gastric cancers, improving the granularity of data for treatment and research. However, the use of unspecified codes like C16.9 can lead to challenges in data analysis and treatment planning.

Resources

Clinical References

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

Coding & Billing References

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

Frequently Asked Questions

What does C16.9 indicate?

C16.9 indicates a malignant neoplasm of the stomach that is unspecified, meaning the exact location or type of gastric cancer has not been determined.

When should I use C16.9?

C16.9 should be used when the specific site of the malignant neoplasm is not documented, and further specificity is not available.

What are the common treatments for gastric cancer?

Common treatments include surgical resection (gastrectomy), chemotherapy, and radiation therapy, depending on the stage of the cancer.