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ICD-10 Guide
ICD-10 CodesC49.11

C49.11

Billable

Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder

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

Code Description

ICD-10 C49.11 is a billable code used to indicate a diagnosis of malignant neoplasm of connective and soft tissue of right upper limb, including shoulder.

Key Diagnostic Point:

C49.11 refers to malignant neoplasms arising from connective and soft tissues in the right upper limb, including the shoulder. These tumors are classified as soft tissue sarcomas, which are rare and can originate from various types of connective tissues such as fat, muscle, nerves, fibrous tissues, blood vessels, and lymphatic tissues. The clinical presentation may include a palpable mass, pain, or functional impairment in the affected limb. Diagnosis typically involves imaging studies such as MRI or CT scans, followed by biopsy for histological confirmation. Grading of soft tissue sarcomas is crucial, as it influences treatment decisions and prognosis. Low-grade tumors tend to be less aggressive, while high-grade tumors are more likely to metastasize. Multidisciplinary management is essential, involving surgical oncologists, medical oncologists, and radiation oncologists to optimize treatment outcomes. Surgical resection is the primary treatment modality, often followed by adjuvant therapies depending on the tumor's grade and stage.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of soft tissue sarcoma types and their specific coding requirements
  • Need for precise documentation of tumor location and characteristics
  • Grading and staging complexities that influence treatment and coding
  • Potential for multiple co-existing conditions affecting coding

Audit Risk Factors

  • Inadequate documentation of tumor characteristics
  • Failure to specify laterality (right vs. left)
  • Misclassification of tumor grade
  • Lack of supporting imaging or pathology reports

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Diagnosis and management of soft tissue sarcomas, including surgical interventions and chemotherapy.

Billing Considerations

Ensure accurate grading and staging documentation to support treatment decisions.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing tumor size, location, and characteristics.

Common Clinical Scenarios

Pre-operative imaging for surgical planning and post-operative follow-up.

Billing Considerations

Clear documentation of imaging findings to support coding and treatment planning.

Coding Guidelines

Inclusion Criteria

Use C49.11 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of the tumor's location, histology, and grade
  • Include any relevant co
  • existing conditions that may impact treatment

Exclusion Criteria

Do NOT use C49.11 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

19301CPT Code

Mastectomy, partial

Clinical Scenario

Used in cases where sarcoma involves breast tissue.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Oncology specialists must ensure accurate coding of tumor type.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of soft tissue sarcomas, improving data accuracy and enhancing the ability to track treatment outcomes and epidemiology.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of soft tissue sarcomas, improving data accuracy and enhancing the ability to track treatment outcomes and epidemiology.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of soft tissue sarcomas, improving data accuracy and enhancing the ability to track treatment outcomes and epidemiology.

Resources

Clinical References

  • •
    American Cancer Society - Soft Tissue Sarcoma

Coding & Billing References

  • •
    American Cancer Society - Soft Tissue Sarcoma

Frequently Asked Questions

What is the significance of tumor grading in C49.11?

Tumor grading is crucial as it determines the aggressiveness of the cancer and influences treatment decisions. High-grade tumors are more likely to metastasize and may require more aggressive treatment.