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ICD-10 Guide
ICD-10 CodesC67.3

C67.3

Billable

Malignant neoplasm of anterior wall of bladder

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

Code Description

ICD-10 C67.3 is a billable code used to indicate a diagnosis of malignant neoplasm of anterior wall of bladder.

Key Diagnostic Point:

C67.3 refers to a malignant neoplasm located specifically on the anterior wall of the bladder. This type of cancer is part of a broader category of urinary tract malignancies, which can include tumors of the bladder, ureters, and kidneys. The anterior wall of the bladder is the portion that faces the pubic bone, and tumors in this area can lead to various symptoms, including hematuria (blood in urine), dysuria (painful urination), and urinary frequency. Diagnosis typically involves imaging studies such as ultrasound or CT scans, followed by cystoscopy for direct visualization and biopsy. Staging of bladder cancer is crucial for determining the appropriate treatment plan and involves assessing the depth of invasion into the bladder wall and the presence of metastasis. Surgical management may include transurethral resection of the bladder tumor (TURBT) for superficial tumors or radical cystectomy for invasive cases. Adjuvant therapies, including chemotherapy or immunotherapy, may also be indicated based on the tumor's characteristics and staging.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Specificity of the anatomical location (anterior wall)
  • Need for accurate staging information
  • Potential for multiple treatment modalities
  • Variability in documentation practices among providers

Audit Risk Factors

  • Inadequate documentation of tumor staging
  • Failure to specify the exact location of the tumor
  • Misclassification of tumor type (malignant vs. benign)
  • Lack of supporting imaging or pathology reports

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed pathology reports, imaging studies, and surgical notes are essential for accurate coding.

Common Clinical Scenarios

Diagnosis and management of bladder tumors, including TURBT and cystectomy procedures.

Billing Considerations

Urologists must ensure that all relevant staging information is documented to support the coding process.

Oncology

Documentation Requirements

Comprehensive treatment plans, including chemotherapy regimens and follow-up care notes.

Common Clinical Scenarios

Management of advanced bladder cancer, including systemic therapies and palliative care.

Billing Considerations

Oncologists should document the rationale for treatment choices and any clinical trials involved.

Coding Guidelines

Inclusion Criteria

Use C67.3 When
  • According to the ICD
  • CM guidelines, C67
  • 3 should be used when the documentation specifies a malignant neoplasm of the anterior wall of the bladder
  • It is essential to ensure that the diagnosis is confirmed through appropriate clinical documentation, including imaging and pathology reports

Exclusion Criteria

Do NOT use C67.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

52260CPT Code

Cystourethroscopy with biopsy

Clinical Scenario

Used for diagnosis and staging of bladder tumors.

Documentation Requirements

Cystoscopy reports and biopsy results must be included.

Specialty Considerations

Urologists should ensure that the procedure details are thoroughly documented.

51570CPT Code

Radical cystectomy

Clinical Scenario

Performed for invasive bladder cancer treatment.

Documentation Requirements

Operative reports detailing the extent of resection and pathology findings.

Specialty Considerations

Oncologists must document the rationale for surgical intervention.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of bladder cancers, including the anterior wall, which aids in better tracking of treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of bladder cancers, including the anterior wall, which aids in better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of bladder cancers, including the anterior wall, which aids in better tracking of treatment outcomes and resource allocation.

Resources

Clinical References

  • •
    American Urological Association Guidelines
  • •
    National Comprehensive Cancer Network Guidelines

Coding & Billing References

  • •
    American Urological Association Guidelines
  • •
    National Comprehensive Cancer Network Guidelines

Frequently Asked Questions

What is the significance of staging in C67.3?

Staging is crucial as it determines the treatment approach and prognosis for patients with malignant neoplasms of the bladder. Accurate staging helps in deciding whether surgical intervention, chemotherapy, or other therapies are necessary.

How can I ensure accurate coding for C67.3?

To ensure accurate coding, always verify the specific location of the tumor, confirm malignancy through pathology, and document staging information thoroughly. Collaboration with the clinical team can enhance coding accuracy.