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v1.0.0
ICD-10 Guide
ICD-10 CodesChapter 2: NeoplasmsC56

C56

Billable

Malignant neoplasm of ovary

Chapter 2:Neoplasms

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

Code Description

ICD-10 C56 is a billable code used to indicate a diagnosis of malignant neoplasm of ovary.

Key Diagnostic Point:

Malignant neoplasm of the ovary, classified under ICD-10 code C56, refers to cancerous tumors that originate in the ovarian tissue. This condition is a significant concern in gynecologic oncology, as ovarian cancer often presents at an advanced stage due to vague symptoms in early stages. The neoplasm can be classified into various histological types, including serous, mucinous, endometrioid, and clear cell carcinomas. Staging of ovarian cancer is crucial for determining treatment options and prognosis, typically following the FIGO (International Federation of Gynecology and Obstetrics) staging system, which ranges from Stage I (confined to the ovaries) to Stage IV (distant metastasis). CA-125, a tumor marker, is often utilized in the diagnosis and monitoring of ovarian cancer, although it is not specific and can be elevated in other conditions. Surgical approaches, including total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) and debulking surgery, are common treatment modalities, often followed by chemotherapy. Accurate coding for C56 requires thorough documentation of the tumor type, stage, and treatment plan.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of histological types and subtypes
  • Staging complexity and its impact on treatment
  • Use of tumor markers like CA-125 for diagnosis and monitoring
  • Surgical approaches and their documentation requirements

Audit Risk Factors

  • Inadequate documentation of tumor type and stage
  • Failure to document CA-125 levels and their significance
  • Incorrect coding of surgical procedures performed
  • Lack of clarity in treatment plans and follow-up care

Specialty Focus

Medical Specialties

Gynecologic Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, surgical notes, and treatment plans.

Common Clinical Scenarios

Diagnosis of ovarian cancer, staging workup, and treatment planning.

Billing Considerations

Ensure accurate staging and documentation of tumor markers for appropriate coding.

Pathology

Documentation Requirements

Comprehensive histopathological reports and tumor grading.

Common Clinical Scenarios

Evaluation of ovarian biopsy specimens and surgical pathology.

Billing Considerations

Clear differentiation of tumor types and documentation of staging.

Coding Guidelines

Inclusion Criteria

Use C56 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate assignment based on the specific type of ovarian cancer, staging, and treatment
  • Include any relevant secondary diagnoses and document the clinical rationale for the chosen codes

Exclusion Criteria

Do NOT use C56 When
No specific exclusions found.

Related CPT Codes

58150CPT Code

Total abdominal hysterectomy with bilateral salpingo-oophorectomy

Clinical Scenario

Performed for staging and treatment of ovarian cancer.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Ensure alignment with gynecologic oncology standards.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of ovarian cancer, improving the granularity of data collection and enhancing the ability to track treatment outcomes and epidemiological trends.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of ovarian cancer, improving the granularity of data collection and enhancing the ability to track treatment outcomes and epidemiological trends.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of ovarian cancer, improving the granularity of data collection and enhancing the ability to track treatment outcomes and epidemiological trends.

Resources

Clinical References

  • •
    American Cancer Society - Ovarian Cancer

Coding & Billing References

  • •
    American Cancer Society - Ovarian Cancer

Frequently Asked Questions

What is the significance of CA-125 in ovarian cancer?

CA-125 is a tumor marker that can be elevated in ovarian cancer. It is used for diagnosis, monitoring treatment response, and detecting recurrence, but it is not specific to ovarian cancer and can be elevated in other conditions.