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ICD-10 Guide
ICD-10 CodesC25.3

C25.3

Billable

Malignant neoplasm of pancreatic duct

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

Code Description

ICD-10 C25.3 is a billable code used to indicate a diagnosis of malignant neoplasm of pancreatic duct.

Key Diagnostic Point:

Malignant neoplasm of the pancreatic duct, classified under ICD-10 code C25.3, refers to cancer that originates in the ductal cells of the pancreas. This type of cancer is often associated with a poor prognosis due to its late presentation and aggressive nature. The pancreatic duct is responsible for transporting digestive enzymes from the pancreas to the small intestine, and malignancies in this area can obstruct this function, leading to significant clinical symptoms. Diagnosis is typically made through imaging studies such as CT scans, MRIs, and endoscopic ultrasound, often accompanied by biopsy for histological confirmation. The CA 19-9 tumor marker is frequently elevated in patients with pancreatic ductal adenocarcinoma, serving as a useful tool for monitoring disease progression and response to treatment. However, the specificity of CA 19-9 is limited, as it can also be elevated in other conditions. Staging pancreatic cancer can be particularly challenging due to the lack of early symptoms and the tendency for the disease to metastasize quickly, often resulting in a diagnosis at an advanced stage. The overall five-year survival rate for pancreatic ductal adenocarcinoma remains low, underscoring the need for early detection and innovative treatment strategies.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Late-stage diagnosis often complicates coding.
  • Variability in tumor marker levels (CA 19-9) can affect clinical decision-making.
  • Difficulties in staging due to anatomical location and metastasis.
  • Need for precise documentation of tumor characteristics and treatment plans.

Audit Risk Factors

  • Inadequate documentation of staging and treatment plans.
  • Failure to document the use of CA 19-9 levels in treatment monitoring.
  • Misclassification of tumor type or location.
  • 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.

Billing Considerations

Ensure accurate staging and documentation of any metastasis.

Gastroenterology

Documentation Requirements

Endoscopic findings, biopsy results, and imaging studies are crucial.

Common Clinical Scenarios

Patients with obstructive jaundice or pancreatitis symptoms.

Billing Considerations

Document any differential diagnoses to avoid coding errors.

Coding Guidelines

Inclusion Criteria

Use C25.3 When
  • Follow official coding guidelines for neoplasms, ensuring accurate documentation of the primary site, histology, and any associated complications
  • Include staging information when available, and adhere to the guidelines for the use of CA 19
  • 9 levels in treatment monitoring

Exclusion Criteria

Do NOT use C25.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

47563CPT Code

Endoscopic retrograde cholangiopancreatography (ERCP)

Clinical Scenario

Used for diagnosis and potential stenting of obstructed pancreatic duct.

Documentation Requirements

Document indications for ERCP and findings.

Specialty Considerations

Gastroenterology specialists should ensure accurate coding based on findings.

48150CPT Code

Pancreatectomy, total or subtotal

Clinical Scenario

Performed for resection of malignant neoplasm of the pancreas.

Documentation Requirements

Document surgical findings and pathology results.

Specialty Considerations

Oncology specialists must provide detailed operative reports.

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. C25.3 provides a clear distinction for malignant neoplasms of the pancreatic duct, 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. C25.3 provides a clear distinction for malignant neoplasms of the pancreatic duct, which aids in research and treatment planning.

Reimbursement & Billing Impact

reimbursement processes. C25.3 provides a clear distinction for malignant neoplasms of the pancreatic duct, which aids in research and treatment planning.

Resources

Clinical References

  • •
    American Cancer Society - Pancreatic Cancer
  • •
    National Cancer Institute - Pancreatic Cancer Treatment

Coding & Billing References

  • •
    American Cancer Society - Pancreatic Cancer
  • •
    National Cancer Institute - Pancreatic Cancer Treatment

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 ductal adenocarcinoma. 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.

How is pancreatic cancer staged?

Pancreatic cancer is staged using the TNM system, which assesses the size of the tumor (T), the involvement of lymph nodes (N), and the presence of metastasis (M). Accurate staging is crucial for determining treatment options and prognosis.