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ICD-10 Guide
ICD-10 CodesC34.1

C34.1

Billable

Malignant neoplasm of upper lobe, bronchus or lung

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

Code Description

ICD-10 C34.1 is a billable code used to indicate a diagnosis of malignant neoplasm of upper lobe, bronchus or lung.

Key Diagnostic Point:

C34.1 refers to a malignant neoplasm located specifically in the upper lobe of the bronchus or lung. Lung cancer is a leading cause of cancer-related mortality worldwide, with the upper lobe being a common site for tumor development. The primary risk factor for lung cancer is a history of smoking, which accounts for approximately 85% of cases. Other risk factors include exposure to secondhand smoke, radon gas, asbestos, and certain occupational exposures. Staging of lung cancer is crucial for determining treatment options and prognosis, typically classified using the TNM system (Tumor, Node, Metastasis). Molecular markers, such as EGFR mutations and ALK rearrangements, play a significant role in guiding targeted therapies. Treatment algorithms may include surgery, chemotherapy, radiation therapy, and immunotherapy, depending on the stage and specific characteristics of the tumor. Accurate coding of C34.1 is essential for appropriate treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in staging and treatment options based on tumor characteristics
  • Need for precise documentation of smoking history and risk factors
  • Differentiation between primary lung cancer and metastatic disease
  • Inclusion of molecular markers in treatment planning

Audit Risk Factors

  • Inadequate documentation of smoking history
  • Failure to document staging details
  • Misclassification of tumor type or location
  • Omission of molecular testing results

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Initial diagnosis of lung cancer, staging workup, and treatment planning.

Billing Considerations

Ensure all molecular testing results are documented to support targeted therapy coding.

Pulmonology

Documentation Requirements

Comprehensive pulmonary function tests and imaging studies.

Common Clinical Scenarios

Management of lung cancer symptoms and complications, pre-operative assessments.

Billing Considerations

Document any co-existing pulmonary conditions that may affect treatment.

Coding Guidelines

Inclusion Criteria

Use C34.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the tumor's location, stage, and any relevant molecular markers

Exclusion Criteria

Do NOT use C34.1 When
  • Exclude codes for benign neoplasms or metastatic disease unless specified

Related ICD-10 Codes

Related CPT Codes

32405CPT Code

Video-assisted thoracoscopic lobectomy

Clinical Scenario

Used for surgical resection of lung tumors.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Oncology specialists should ensure accurate coding based on the surgical approach.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of lung cancer, including the ability to capture the exact location and characteristics of the tumor, which is crucial for treatment and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of lung cancer, including the ability to capture the exact location and characteristics of the tumor, which is crucial for treatment and research.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of lung cancer, including the ability to capture the exact location and characteristics of the tumor, which is crucial for treatment and research.

Resources

Clinical References

  • •
    American Cancer Society - Lung Cancer

Coding & Billing References

  • •
    American Cancer Society - Lung Cancer

Frequently Asked Questions

What is the significance of staging in lung cancer?

Staging determines the extent of cancer spread and is crucial for guiding treatment decisions and predicting outcomes.

How does smoking history impact lung cancer coding?

Smoking history is a critical risk factor for lung cancer and must be documented to support the diagnosis and treatment plan.