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ICD-10 Guide
ICD-10 CodesC67.5

C67.5

Billable

Malignant neoplasm of bladder neck

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

Code Description

ICD-10 C67.5 is a billable code used to indicate a diagnosis of malignant neoplasm of bladder neck.

Key Diagnostic Point:

Malignant neoplasm of the bladder neck is a type of cancer that arises in the area where the bladder connects to the urethra. This condition is characterized by the uncontrolled growth of abnormal cells in the bladder neck, which can lead to obstruction of urine flow and other urinary symptoms. The bladder neck is a critical anatomical region that plays a significant role in urinary continence and the regulation of urine flow. Symptoms may include hematuria (blood in urine), dysuria (painful urination), and urinary frequency or urgency. Diagnosis typically involves imaging studies such as ultrasound, CT scans, or MRI, along with cystoscopy for direct visualization and biopsy of the tumor. Staging of bladder neck cancer is crucial for determining the extent of the disease and guiding treatment options, which may include surgery, radiation therapy, and chemotherapy. Surgical management often involves transurethral resection of the bladder tumor (TURBT) or radical cystectomy, depending on the tumor's size and invasiveness. Accurate coding for this condition is essential for appropriate treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires knowledge of urinary tract anatomy and pathology.
  • Staging criteria must be understood for accurate coding.
  • Differentiation from benign conditions is necessary.
  • Documentation must specify tumor size and invasion depth.

Audit Risk Factors

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

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed surgical notes, pathology reports, imaging studies, and staging information.

Common Clinical Scenarios

Diagnosis and management of bladder neck tumors, preoperative assessments, and postoperative follow-ups.

Billing Considerations

Urologists must ensure that all relevant details about tumor characteristics and treatment plans are documented for accurate coding.

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Management of advanced bladder cancer, coordination of multidisciplinary care, and palliative care considerations.

Billing Considerations

Oncologists should document the rationale for treatment choices and any complications that arise during therapy.

Coding Guidelines

Inclusion Criteria

Use C67.5 When
  • According to the official ICD
  • CM coding guidelines, C67
  • 5 should be used when the documentation specifies a malignant neoplasm of the bladder neck
  • Coders must ensure that the diagnosis is confirmed by pathology and that staging is documented

Exclusion Criteria

Do NOT use C67.5 When
  • Exclusions include benign neoplasms and unspecified bladder malignancies

Related ICD-10 Codes

Related CPT Codes

52281CPT Code

Cystourethroscopy with biopsy

Clinical Scenario

Used for diagnosis of bladder neck tumors.

Documentation Requirements

Cystoscopy report and biopsy results.

Specialty Considerations

Urologists must document findings and any interventions performed.

51570CPT Code

Radical cystectomy

Clinical Scenario

Performed for invasive bladder neck cancer.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Oncologists should 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 malignancies, including the bladder neck. This specificity aids in better tracking of treatment outcomes and resource allocation in healthcare settings.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of bladder malignancies, including the bladder neck. This specificity aids in better tracking of treatment outcomes and resource allocation in healthcare settings.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of bladder malignancies, including the bladder neck. This specificity aids in better tracking of treatment outcomes and resource allocation in healthcare settings.

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 bladder neck cancer?

Staging is crucial as it determines the extent of the disease, guides treatment options, and helps predict patient outcomes. Accurate staging is essential for appropriate coding and reimbursement.

How can I ensure accurate coding for bladder neck tumors?

Ensure that all documentation is complete, including pathology reports, imaging studies, and surgical notes. Pay attention to the specifics of tumor location and staging.