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v1.0.0
ICD-10 Guide
ICD-10 CodesChapter 2: NeoplasmsC26

C26

Billable

Malignant neoplasm of other and ill-defined digestive organs

Chapter 2:Neoplasms

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

Code Description

ICD-10 C26 is a billable code used to indicate a diagnosis of malignant neoplasm of other and ill-defined digestive organs.

Key Diagnostic Point:

C26 refers to malignant neoplasms located in various parts of the digestive system that are not classified under more specific categories. This includes cancers of the esophagus, stomach, intestines, liver, pancreas, and other organs that may not have a clear anatomical definition. These neoplasms can arise from different types of cells, including epithelial, mesenchymal, and neuroendocrine cells. Symptoms may vary widely depending on the location and extent of the tumor, but common presentations include abdominal pain, weight loss, changes in bowel habits, and gastrointestinal bleeding. Diagnosis typically involves imaging studies, endoscopy, and biopsy to confirm malignancy. Treatment options may include surgery, chemotherapy, radiation therapy, or a combination of these modalities. Accurate coding is crucial for appropriate treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential primary sites leading to ambiguity in coding.
  • Need for precise documentation of tumor location and type.
  • Differentiation from benign conditions and other malignancies.
  • Potential for overlapping symptoms with other digestive disorders.

Audit Risk Factors

  • Inadequate documentation of tumor location.
  • Failure to specify the type of malignancy.
  • Misclassification of benign versus malignant conditions.
  • Inconsistent coding across different encounters.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Diagnosis and management of newly identified digestive organ malignancies.

Billing Considerations

Ensure all relevant diagnostic tests and treatment modalities are documented.

Gastroenterology

Documentation Requirements

Endoscopy reports, biopsy results, and clinical notes on symptoms.

Common Clinical Scenarios

Evaluation of patients with gastrointestinal symptoms leading to cancer diagnosis.

Billing Considerations

Document the rationale for diagnostic procedures and findings.

Coding Guidelines

Inclusion Criteria

Use C26 When
  • Follow ICD
  • CM guidelines for coding neoplasms, including the need for specificity regarding the site and type of malignancy
  • Ensure compliance with the official coding conventions and guidelines for malignant neoplasms

Exclusion Criteria

Do NOT use C26 When
No specific exclusions found.

Related CPT Codes

44140CPT Code

Colectomy, partial

Clinical Scenario

Used for surgical intervention in cases of colon cancer.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Oncology and surgery must coordinate documentation for accurate coding.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of malignant neoplasms, improving the accuracy of data collection and reimbursement processes. C26 captures a broader category, necessitating careful documentation to ensure appropriate coding.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of malignant neoplasms, improving the accuracy of data collection and reimbursement processes. C26 captures a broader category, necessitating careful documentation to ensure appropriate coding.

Reimbursement & Billing Impact

reimbursement processes. C26 captures a broader category, necessitating careful documentation to ensure appropriate coding.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What documentation is needed to support the use of code C26?

Documentation should include a clear diagnosis of the malignancy, imaging studies, pathology reports, and treatment plans. All clinical findings should be well-documented to support the coding.