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ICD-10 Guide
ICD-10 CodesC26.1

C26.1

Billable

Malignant neoplasm of spleen

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

Code Description

ICD-10 C26.1 is a billable code used to indicate a diagnosis of malignant neoplasm of spleen.

Key Diagnostic Point:

Malignant neoplasm of the spleen, classified under ICD-10 code C26.1, refers to cancerous growths that originate in the splenic tissue. The spleen plays a crucial role in filtering blood and supporting the immune system. Malignancies in this organ can arise from various cell types, including lymphoid tissue, leading to conditions such as splenic lymphoma or secondary involvement from systemic malignancies. Symptoms may include splenomegaly, abdominal pain, fatigue, and unintended weight loss. Diagnosis typically involves imaging studies such as ultrasound or CT scans, along with biopsy for histological confirmation. Treatment options may include surgical intervention, chemotherapy, or radiation therapy, depending on the stage and type of cancer. Accurate coding is essential for proper treatment reimbursement and tracking of cancer incidence, making it vital for coders to understand the nuances of this diagnosis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between primary and secondary malignancies of the spleen.
  • Understanding the various histological types of splenic neoplasms.
  • Navigating the documentation requirements for staging and treatment.
  • Identifying associated conditions that may complicate coding.

Audit Risk Factors

  • Inadequate documentation of the type of malignancy.
  • Failure to specify whether the neoplasm is primary or secondary.
  • Lack of staging information in the medical record.
  • Misclassification of splenic involvement in systemic diseases.

Specialty Focus

Medical Specialties

Hematology/Oncology

Documentation Requirements

Detailed pathology reports, treatment plans, and follow-up notes.

Common Clinical Scenarios

Diagnosis and management of splenic lymphoma, treatment of secondary splenic involvement.

Billing Considerations

Need for comprehensive staging and treatment documentation to support coding.

General Surgery

Documentation Requirements

Operative reports, pre-operative assessments, and post-operative follow-ups.

Common Clinical Scenarios

Splenectomy for malignant neoplasms, management of splenic abscesses.

Billing Considerations

Accurate coding of surgical procedures related to splenic malignancies.

Coding Guidelines

Inclusion Criteria

Use C26.1 When
  • According to ICD
  • 10 coding guidelines, C26
  • 1 should be used when there is clear documentation of a malignant neoplasm of the spleen
  • Coders must ensure that the diagnosis is confirmed through appropriate imaging and pathology reports

Exclusion Criteria

Do NOT use C26.1 When
  • Exclusion criteria include benign neoplasms and conditions not primarily affecting the spleen

Related ICD-10 Codes

Related CPT Codes

38100CPT Code

Splenectomy, total

Clinical Scenario

Performed for malignant neoplasm of the spleen.

Documentation Requirements

Operative report detailing the indication for surgery and findings.

Specialty Considerations

Ensure that the surgical indication aligns with the diagnosis of C26.1.

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, including those of the spleen. This specificity aids in better tracking of cancer incidence and treatment outcomes, improving overall patient care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of malignant neoplasms, including those of the spleen. This specificity aids in better tracking of cancer incidence and treatment outcomes, improving overall patient care.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of malignant neoplasms, including those of the spleen. This specificity aids in better tracking of cancer incidence and treatment outcomes, improving overall patient care.

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 is the primary documentation needed for coding C26.1?

Coders need to ensure that pathology reports confirm the malignancy, along with imaging studies that support the diagnosis of malignant neoplasm of the spleen.