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v1.0.0
ICD-10 Guide
ICD-10 CodesC25.9

C25.9

Billable

Malignant neoplasm of pancreas, unspecified

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

Code Description

ICD-10 C25.9 is a billable code used to indicate a diagnosis of malignant neoplasm of pancreas, unspecified.

Key Diagnostic Point:

Malignant neoplasm of the pancreas, unspecified (C25.9), refers to a cancerous tumor located in the pancreas that has not been further classified. Pancreatic cancer is often diagnosed at an advanced stage due to its asymptomatic nature in early stages, leading to a poor prognosis. The pancreas is a vital organ involved in digestion and blood sugar regulation, and malignancies can disrupt these functions. Staging pancreatic cancer can be challenging, as it often presents with vague symptoms such as abdominal pain, weight loss, and jaundice. The CA 19-9 tumor marker is frequently used in the diagnosis and monitoring of pancreatic cancer, although it is not specific to this condition and can be elevated in other diseases. The prognosis for patients with pancreatic cancer 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 surgery, chemotherapy, and radiation therapy, but the effectiveness varies significantly among patients.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Unspecified nature of the neoplasm complicates treatment planning.
  • Staging difficulties due to late presentation.
  • Variability in CA 19-9 levels and interpretation.
  • Need for comprehensive documentation to support diagnosis.

Audit Risk Factors

  • Inadequate documentation of staging and treatment plans.
  • Misuse of unspecified codes leading to potential denials.
  • Failure to document CA 19-9 levels and their significance.
  • Inconsistent coding practices across specialties.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Diagnosis confirmation, treatment planning, and monitoring of disease progression.

Billing Considerations

Ensure accurate staging and documentation of CA 19-9 levels.

Gastroenterology

Documentation Requirements

Endoscopy reports, imaging results, and biopsy findings.

Common Clinical Scenarios

Evaluation of abdominal pain, jaundice, and weight loss.

Billing Considerations

Document differential diagnoses to support coding decisions.

Coding Guidelines

Inclusion Criteria

Use C25.9 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the neoplasm is confirmed as malignant and unspecified
  • Document all relevant clinical findings and treatment plans to support the use of this code

Exclusion Criteria

Do NOT use C25.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

47563CPT Code

Laparoscopic cholecystectomy

Clinical Scenario

Used in cases where gallbladder disease is suspected alongside pancreatic cancer.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Ensure that the relationship between gallbladder disease and pancreatic cancer is 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 cancers, improving data accuracy and treatment tracking. C25.9, while unspecified, highlights the need for thorough documentation to support the diagnosis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pancreatic cancers, improving data accuracy and treatment tracking. C25.9, while unspecified, highlights the need for thorough documentation to support the diagnosis.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of pancreatic cancers, improving data accuracy and treatment tracking. C25.9, while unspecified, highlights the need for thorough documentation to support the diagnosis.

Resources

Clinical References

  • •
    American Cancer Society - Pancreatic Cancer

Coding & Billing References

  • •
    American Cancer Society - Pancreatic Cancer

Frequently Asked Questions

What does C25.9 indicate?

C25.9 indicates a malignant neoplasm of the pancreas that is unspecified, meaning the specific type of pancreatic cancer has not been classified.

When should I use C25.9?

Use C25.9 when a patient has a confirmed diagnosis of pancreatic cancer, but the specific type or location within the pancreas is not documented.