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ICD-10 Guide
ICD-10 CodesC34.31

C34.31

Billable

Malignant neoplasm of lower lobe, right bronchus or lung

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

Code Description

ICD-10 C34.31 is a billable code used to indicate a diagnosis of malignant neoplasm of lower lobe, right bronchus or lung.

Key Diagnostic Point:

C34.31 refers to a malignant neoplasm located in the lower lobe of the right lung or bronchus. This diagnosis is commonly associated with lung cancer, which is characterized by uncontrolled cell growth in lung tissues. The primary risk factor for lung cancer is a history of smoking, with both active and passive exposure contributing significantly to the disease's incidence. Staging of lung cancer is crucial for determining treatment options and prognosis, typically classified using the TNM system, which assesses tumor size (T), lymph node involvement (N), and metastasis (M). Molecular markers, such as EGFR mutations and ALK rearrangements, play a vital role in guiding targeted therapies. Treatment algorithms often include a combination of surgery, chemotherapy, radiation therapy, and immunotherapy, depending on the stage and specific characteristics of the tumor. Accurate coding of C34.31 requires thorough documentation of the patient's smoking history, staging details, and any molecular testing results to ensure appropriate treatment and reimbursement.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for precise staging information (TNM classification)
  • Documentation of smoking history and risk factors
  • Inclusion of molecular markers for targeted therapy
  • Differentiation from other lung cancer types

Audit Risk Factors

  • Incomplete documentation of staging
  • Lack of smoking history details
  • Failure to document molecular testing results
  • Misclassification of tumor location

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, treatment planning.

Billing Considerations

Ensure all molecular testing results are documented for targeted therapies.

Pulmonology

Documentation Requirements

Pulmonary function tests, imaging, and smoking history.

Common Clinical Scenarios

Evaluation of lung nodules, management of lung cancer patients.

Billing Considerations

Document any comorbid respiratory conditions that may affect treatment.

Coding Guidelines

Inclusion Criteria

Use C34.31 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the primary site, laterality, and any relevant staging information
  • Include any associated conditions or complications

Exclusion Criteria

Do NOT use C34.31 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

32551CPT Code

Thoracentesis, needle drainage of pleural effusion

Clinical Scenario

Used when a patient with lung cancer presents with pleural effusion.

Documentation Requirements

Document the indication for the procedure and any imaging guidance used.

Specialty Considerations

Pulmonologists should ensure proper technique and follow-up care.

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, improving the granularity of data for treatment and research. C34.31 provides a clear indication of the tumor's location, which is essential for treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of lung cancer, improving the granularity of data for treatment and research. C34.31 provides a clear indication of the tumor's location, which is essential for treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of lung cancer, improving the granularity of data for treatment and research. C34.31 provides a clear indication of the tumor's location, which is essential for treatment planning.

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 coding?

Staging is crucial as it determines the extent of the disease, guides treatment options, and influences prognosis. Accurate staging must be documented to support the coding of C34.31.