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v1.0.0
ICD-10 Guide
ICD-10 CodesC25.0

C25.0

Billable

Malignant neoplasm of head of pancreas

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

Code Description

ICD-10 C25.0 is a billable code used to indicate a diagnosis of malignant neoplasm of head of pancreas.

Key Diagnostic Point:

Malignant neoplasm of the head of the pancreas is a serious and often fatal condition characterized by the uncontrolled growth of abnormal cells in the pancreatic tissue located at the head of the pancreas. This type of cancer is typically diagnosed at an advanced stage due to its asymptomatic nature in early stages, leading to significant challenges in treatment and management. Symptoms may include jaundice, weight loss, abdominal pain, and changes in stool. The prognosis for patients with pancreatic cancer is generally poor, with a five-year survival rate of less than 10%. Staging is complicated by the lack of early symptoms and the tendency for the cancer to metastasize quickly. The CA 19-9 tumor marker is often elevated in patients with pancreatic cancer and can be used to monitor treatment response and disease progression. However, it is not specific to pancreatic cancer and can be elevated in other conditions, which complicates its use in diagnosis.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Difficulty in staging due to late presentation of symptoms
  • Variability in CA 19-9 levels and their interpretation
  • Need for comprehensive documentation of imaging and pathology results
  • Potential for metastasis complicating treatment coding

Audit Risk Factors

  • Inadequate documentation of staging and treatment plans
  • Misinterpretation of CA 19-9 levels
  • Failure to document metastasis or local invasion
  • Lack of clarity in pathology reports

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with jaundice, weight loss, and abdominal pain; follow-up after chemotherapy.

Billing Considerations

Ensure accurate staging and documentation of any metastasis.

Gastroenterology

Documentation Requirements

Endoscopic findings, imaging results, and laboratory tests including CA 19-9 levels.

Common Clinical Scenarios

Evaluation of obstructive jaundice; management of pancreatic insufficiency.

Billing Considerations

Document any interventions performed, such as stenting or biopsies.

Coding Guidelines

Inclusion Criteria

Use C25.0 When
  • Follow official ICD
  • CM guidelines for coding neoplasms, including the need for specificity in documentation regarding the site and extent of the tumor
  • Ensure compliance with guidelines for staging and treatment documentation

Exclusion Criteria

Do NOT use C25.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

47563CPT Code

Laparoscopic cholecystectomy

Clinical Scenario

Often performed in conjunction with pancreatic cancer treatment if gallbladder involvement is suspected.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Ensure that the oncology team is aware of any surgical interventions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of pancreatic cancers, improving the accuracy of data collection and reimbursement processes. C25.0 provides a clear distinction for malignant neoplasms of the head of the pancreas, which aids in research and treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pancreatic cancers, improving the accuracy of data collection and reimbursement processes. C25.0 provides a clear distinction for malignant neoplasms of the head of the pancreas, which aids in research and treatment planning.

Reimbursement & Billing Impact

reimbursement processes. C25.0 provides a clear distinction for malignant neoplasms of the head of the pancreas, which aids in research and treatment planning.

Resources

Clinical References

  • •
    American Cancer Society - Pancreatic Cancer

Coding & Billing References

  • •
    American Cancer Society - Pancreatic Cancer

Frequently Asked Questions

What is the significance of CA 19-9 in pancreatic cancer?

CA 19-9 is a tumor marker that is often elevated in patients with pancreatic cancer. It is used to monitor treatment response and disease progression, but it is not specific to pancreatic cancer and can be elevated in other conditions.