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v1.0.0
ICD-10 Guide
ICD-10 CodesC38.0

C38.0

Billable

Malignant neoplasm of heart

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

Code Description

ICD-10 C38.0 is a billable code used to indicate a diagnosis of malignant neoplasm of heart.

Key Diagnostic Point:

Malignant neoplasm of the heart is a rare but serious condition characterized by the presence of cancerous cells in the heart tissue. This neoplasm can arise from the heart muscle (myocardium), the heart lining (endocardium), or the pericardium. Symptoms may include chest pain, shortness of breath, arrhythmias, and signs of heart failure. Diagnosis typically involves imaging studies such as echocardiograms, CT scans, or MRIs, alongside biopsy procedures to confirm malignancy. Treatment options may include surgical resection, chemotherapy, and radiation therapy, depending on the tumor's type, size, and location. The involvement of mediastinal structures can complicate the clinical picture, as tumors may invade surrounding tissues, necessitating a multidisciplinary approach for management. Surgical considerations are paramount, as the heart's unique anatomy and function require careful planning to minimize risks during intervention. The prognosis varies significantly based on the tumor's characteristics and the timeliness of treatment.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Rarity of the condition leading to limited coding experience
  • Variability in tumor types and treatment protocols
  • Need for precise documentation of tumor location and characteristics
  • Potential for involvement of multiple specialties in treatment

Audit Risk Factors

  • Inadequate documentation of tumor characteristics
  • Failure to specify the location of the neoplasm
  • Misclassification of benign versus malignant tumors
  • Lack of clarity in treatment plans and outcomes

Specialty Focus

Medical Specialties

Cardiology

Documentation Requirements

Detailed imaging reports, biopsy results, and treatment plans.

Common Clinical Scenarios

Diagnosis of cardiac tumors, management of arrhythmias due to neoplasms.

Billing Considerations

Ensure clear documentation of symptoms and diagnostic findings to support coding.

Oncology

Documentation Requirements

Pathology reports, staging information, and treatment response documentation.

Common Clinical Scenarios

Chemotherapy administration, surgical oncology interventions.

Billing Considerations

Accurate staging and grading of tumors are critical for coding and treatment planning.

Coding Guidelines

Inclusion Criteria

Use C38.0 When
  • Follow official ICD
  • CM guidelines for coding neoplasms, including specificity in tumor location and type
  • Ensure compliance with the guidelines for coding malignancies, including staging and treatment details

Exclusion Criteria

Do NOT use C38.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

33206CPT Code

Insertion of permanent pacemaker

Clinical Scenario

Used in patients with arrhythmias due to cardiac tumors.

Documentation Requirements

Document indication for pacemaker placement and any related cardiac evaluations.

Specialty Considerations

Cardiology specialists must ensure clear documentation of the relationship between the tumor and arrhythmias.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding malignant neoplasms, including those of the heart, which aids in better tracking of treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding malignant neoplasms, including those of the heart, which aids in better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding malignant neoplasms, including those of the heart, which aids in better tracking of treatment outcomes and resource allocation.

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 are the common symptoms of malignant neoplasm of the heart?

Common symptoms include chest pain, shortness of breath, arrhythmias, and signs of heart failure. Patients may also experience fatigue and swelling in the legs or abdomen.