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ICD-10 Guide
ICD-10 CodesC25.1

C25.1

Billable

Malignant neoplasm of body of pancreas

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

Code Description

ICD-10 C25.1 is a billable code used to indicate a diagnosis of malignant neoplasm of body of pancreas.

Key Diagnostic Point:

Malignant neoplasm of the body of the pancreas, commonly referred to as pancreatic cancer, is a highly aggressive form of cancer that originates in the pancreatic tissue. The pancreas is a vital organ involved in digestion and blood sugar regulation. The body of the pancreas is the central portion, and tumors in this area can lead to obstructive jaundice, weight loss, and abdominal pain. Staging pancreatic cancer is particularly challenging due to the lack of early symptoms and the tendency for the disease to be diagnosed at an advanced stage. The CA 19-9 tumor marker is often elevated in patients with pancreatic cancer and can be used to monitor treatment response, although it is not specific to the disease. The prognosis for patients diagnosed with malignant neoplasm of the body of the pancreas is generally poor, with a five-year survival rate of less than 10%, primarily due to late-stage diagnosis and aggressive tumor behavior. Treatment options may include surgical resection, chemotherapy, and radiation therapy, but the effectiveness is often limited by the cancer's advanced stage at diagnosis.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Difficulty in staging due to late presentation of symptoms
  • Variability in tumor markers (CA 19-9) and their interpretation
  • Need for precise documentation of tumor location and extent
  • Potential for multiple treatment modalities affecting coding

Audit Risk Factors

  • Inadequate documentation of staging and tumor markers
  • Misclassification of tumor location
  • Failure to document treatment plans and responses
  • Inconsistent use of CA 19-9 levels in clinical notes

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, or abdominal pain; follow-up after chemotherapy.

Billing Considerations

Ensure accurate staging and documentation of tumor markers for treatment planning.

Gastroenterology

Documentation Requirements

Endoscopic reports, imaging studies, and biopsy results are critical.

Common Clinical Scenarios

Patients with obstructive jaundice or unexplained weight loss; evaluation of pancreatic masses.

Billing Considerations

Document the clinical rationale for imaging and biopsy to support coding.

Coding Guidelines

Inclusion Criteria

Use C25.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the tumor's location, stage, and any associated conditions
  • Include any relevant imaging or pathology reports to support the diagnosis

Exclusion Criteria

Do NOT use C25.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

47563CPT Code

Laparoscopic pancreatectomy

Clinical Scenario

Used for surgical resection of pancreatic tumors.

Documentation Requirements

Operative reports detailing the procedure and findings.

Specialty Considerations

Ensure that the surgical approach and tumor location are clearly documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of pancreatic cancer, improving the accuracy of data collection and reimbursement processes. C25.1 provides a clear distinction for tumors located in the body of the pancreas, which aids in treatment planning and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pancreatic cancer, improving the accuracy of data collection and reimbursement processes. C25.1 provides a clear distinction for tumors located in the body of the pancreas, which aids in treatment planning and research.

Reimbursement & Billing Impact

reimbursement processes. C25.1 provides a clear distinction for tumors located in the body of the pancreas, which aids in treatment planning and research.

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, although it is not specific to pancreatic cancer and can be elevated in other conditions.