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ICD-10 Guide
ICD-10 CodesC78.6

C78.6

Billable

Secondary malignant neoplasm of retroperitoneum and peritoneum

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

Code Description

ICD-10 C78.6 is a billable code used to indicate a diagnosis of secondary malignant neoplasm of retroperitoneum and peritoneum.

Key Diagnostic Point:

C78.6 refers to secondary malignant neoplasms that have metastasized to the retroperitoneum and peritoneum from a primary cancer site. This condition indicates that cancer cells have spread from their original site to these areas, which can include the abdominal cavity and surrounding structures. The retroperitoneum is the space behind the peritoneum, which houses organs such as the kidneys, adrenal glands, and major blood vessels. The peritoneum is a serous membrane that lines the abdominal cavity and covers the abdominal organs. Patients with C78.6 may present with symptoms such as abdominal pain, ascites, or gastrointestinal disturbances. The diagnosis often involves imaging studies like CT scans or MRIs to identify the extent of metastatic disease. Staging of the cancer is crucial for determining prognosis and treatment options, as well as for palliative care considerations, which may focus on symptom management and quality of life rather than curative treatment. Accurate coding of this condition is essential for appropriate treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Determining the primary site of cancer can be challenging.
  • Need for precise staging information to guide treatment.
  • Differentiating between primary and secondary tumors in imaging.
  • Documentation of metastatic spread requires thorough clinical notes.

Audit Risk Factors

  • Inadequate documentation of the primary cancer site.
  • Failure to document staging information.
  • Misidentification of the metastatic site.
  • Lack of clarity in palliative care documentation.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed history of the primary cancer, staging information, and treatment plans.

Common Clinical Scenarios

Patients with known primary cancers presenting with abdominal symptoms or imaging findings suggestive of metastasis.

Billing Considerations

Ensure that the primary site is clearly documented to support the use of C78.6.

Palliative Care

Documentation Requirements

Comprehensive symptom management plans and goals of care discussions.

Common Clinical Scenarios

Patients with advanced cancer requiring symptom relief and quality of life improvements.

Billing Considerations

Documentation should reflect the focus on palliative care rather than curative intent.

Coding Guidelines

Inclusion Criteria

Use C78.6 When
  • According to ICD
  • 10 coding guidelines, C78
  • 6 should be used when there is clear documentation of metastatic disease to the retroperitoneum and peritoneum
  • Coders must ensure that the primary site of cancer is documented, and staging information is included when applicable

Exclusion Criteria

Do NOT use C78.6 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99214CPT Code

Office visit, established patient, moderate complexity

Clinical Scenario

Used for follow-up visits for patients with metastatic disease.

Documentation Requirements

Document the patient's history, examination findings, and treatment plan.

Specialty Considerations

Oncology specialists should ensure that the visit reflects the complexity of managing metastatic disease.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of metastatic diseases, improving the accuracy of data collection and reimbursement processes. C78.6 provides a clear designation for secondary malignancies in the retroperitoneum and peritoneum, which aids in treatment planning and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of metastatic diseases, improving the accuracy of data collection and reimbursement processes. C78.6 provides a clear designation for secondary malignancies in the retroperitoneum and peritoneum, which aids in treatment planning and research.

Reimbursement & Billing Impact

reimbursement processes. C78.6 provides a clear designation for secondary malignancies in the retroperitoneum and peritoneum, which aids in treatment planning 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 significance of coding C78.6?

Coding C78.6 accurately reflects the presence of metastatic disease in the retroperitoneum and peritoneum, which is crucial for treatment planning, prognosis, and reimbursement.