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ICD-10 Guide
ICD-10 CodesC25.7

C25.7

Billable

Malignant neoplasm of other parts of pancreas

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

Code Description

ICD-10 C25.7 is a billable code used to indicate a diagnosis of malignant neoplasm of other parts of pancreas.

Key Diagnostic Point:

C25.7 refers to malignant neoplasms located in parts of the pancreas that are not classified under more specific codes for the head, body, or tail of the pancreas. Pancreatic cancer is often asymptomatic in its early stages, leading to late diagnosis and poor prognosis. The disease is characterized by the uncontrolled growth of abnormal cells in the pancreas, which can invade surrounding tissues and metastasize to other organs. Staging pancreatic cancer can be particularly challenging due to the pancreas's anatomical location and the often vague symptoms presented by patients. The CA 19-9 tumor marker is frequently used in the diagnosis and monitoring of pancreatic cancer, although it is not exclusively specific to this malignancy. Elevated levels of CA 19-9 can indicate the presence of pancreatic cancer but can also be seen in other conditions, complicating the diagnostic process. The prognosis for patients diagnosed with pancreatic cancer remains poor, with a five-year survival rate of less than 10%, primarily due to late-stage diagnosis and aggressive tumor behavior.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Difficulty in staging due to anatomical location
  • Variability in symptoms leading to late diagnosis
  • Use of CA 19-9 as a non-specific marker
  • Need for comprehensive documentation of tumor characteristics

Audit Risk Factors

  • Inadequate documentation of tumor location
  • Failure to document staging details
  • Misinterpretation of CA 19-9 levels
  • Lack of clarity on metastasis

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Diagnosis and treatment planning for pancreatic cancer, monitoring treatment response.

Billing Considerations

Ensure accurate staging and documentation of tumor markers.

Gastroenterology

Documentation Requirements

Endoscopy reports, imaging results, and biopsy findings.

Common Clinical Scenarios

Evaluation of pancreatic masses, management of complications.

Billing Considerations

Document any gastrointestinal symptoms and their relation to pancreatic pathology.

Coding Guidelines

Inclusion Criteria

Use C25.7 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the tumor's location, staging, and any associated conditions
  • Include details on the patient's clinical history and treatment plan

Exclusion Criteria

Do NOT use C25.7 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

47563CPT Code

Laparoscopic cholecystectomy

Clinical Scenario

Often performed in patients with pancreatic cancer to manage biliary obstruction.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Ensure that the relationship between the procedure and the cancer diagnosis is clearly documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding pancreatic cancer, improving the accuracy of data collection and reimbursement processes. C25.7 provides a clear designation for malignancies in less common parts of the pancreas.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding pancreatic cancer, improving the accuracy of data collection and reimbursement processes. C25.7 provides a clear designation for malignancies in less common parts of the pancreas.

Reimbursement & Billing Impact

reimbursement processes. C25.7 provides a clear designation for malignancies in less common parts of the pancreas.

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 can help in diagnosing and monitoring pancreatic cancer. Elevated levels may indicate the presence of cancer, but they are not specific and can be elevated in other conditions.