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v1.0.0
ICD-10 Guide
ICD-10 CodesC48.1

C48.1

Billable

Malignant neoplasm of specified parts of peritoneum

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

Code Description

ICD-10 C48.1 is a billable code used to indicate a diagnosis of malignant neoplasm of specified parts of peritoneum.

Key Diagnostic Point:

C48.1 refers to malignant neoplasms located in specific parts of the peritoneum, which is the serous membrane lining the abdominal cavity and covering the abdominal organs. These neoplasms can arise from various tissues, including soft tissues, and may present as sarcomas, which are cancers originating from connective tissues. The peritoneum can be affected by primary tumors or secondary tumors that have metastasized from other sites. Grading of these tumors is crucial, as it helps determine the aggressiveness of the cancer and guides treatment decisions. Multidisciplinary management is essential for optimal outcomes, involving surgical oncologists, medical oncologists, radiation oncologists, and palliative care specialists. Treatment may include surgical resection, chemotherapy, and radiation therapy, depending on the tumor's type, stage, and location. Accurate coding requires thorough documentation of the tumor's characteristics, treatment plans, and any associated conditions, as these factors significantly influence patient management and prognosis.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of soft tissue sarcomas that can affect the peritoneum
  • Need for precise documentation of tumor type and grade
  • Potential for metastasis complicating coding
  • Multidisciplinary treatment approaches requiring detailed records

Audit Risk Factors

  • Inadequate documentation of tumor type and grade
  • Failure to capture multidisciplinary treatment details
  • Misclassification of primary vs. metastatic tumors
  • Lack of clarity in surgical notes regarding resection margins

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Diagnosis and management of soft tissue sarcomas in the peritoneum, including staging and treatment response.

Billing Considerations

Ensure accurate grading and staging documentation to reflect the tumor's aggressiveness.

Surgical Oncology

Documentation Requirements

Operative reports detailing the extent of resection and any complications.

Common Clinical Scenarios

Surgical intervention for resectable peritoneal sarcomas and assessment of margins.

Billing Considerations

Documenting the surgical approach and any adjuvant therapies planned post-surgery.

Coding Guidelines

Inclusion Criteria

Use C48.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the tumor's location, type, and any associated conditions
  • Include details on the grading of the tumor and treatment modalities employed

Exclusion Criteria

Do NOT use C48.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

49000CPT Code

Exploratory laparotomy

Clinical Scenario

Used when a patient presents with abdominal pain and a suspected malignant neoplasm.

Documentation Requirements

Operative report detailing findings and any biopsies taken.

Specialty Considerations

Surgical oncology must document the extent of the procedure and any findings.

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. C48.1 provides a clearer picture of the types of tumors affecting the peritoneum, facilitating better patient management and research.

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. C48.1 provides a clearer picture of the types of tumors affecting the peritoneum, facilitating better patient management and research.

Reimbursement & Billing Impact

reimbursement processes. C48.1 provides a clearer picture of the types of tumors affecting the peritoneum, facilitating better patient management and research.

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 difference between C48.1 and C48.0?

C48.1 specifies malignant neoplasms of certain parts of the peritoneum, while C48.0 is used for unspecified malignant neoplasms of the peritoneum. Accurate documentation is crucial for selecting the appropriate code.