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v1.0.0
ICD-10 Guide
ICD-10 CodesChapter 2: NeoplasmsD13

D13

Billable

Benign neoplasm of other and ill-defined parts of digestive system

Chapter 2:Neoplasms

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

Code Description

ICD-10 D13 is a billable code used to indicate a diagnosis of benign neoplasm of other and ill-defined parts of digestive system.

Key Diagnostic Point:

Benign neoplasms of the digestive system are non-cancerous growths that can occur in various parts of the gastrointestinal tract, including the esophagus, stomach, intestines, and other associated structures. These neoplasms can arise from different types of tissues, such as epithelial, connective, or muscle tissues. While benign, these growths can lead to symptoms such as obstruction, bleeding, or discomfort, necessitating medical evaluation. Surveillance for benign neoplasms is crucial, as some may have the potential to undergo malignant transformation over time, particularly if they exhibit atypical features or if they are located in areas prone to irritation or trauma. Regular monitoring through imaging studies or endoscopic evaluations may be recommended based on the neoplasm's characteristics and the patient's clinical history. Accurate coding of benign neoplasms is essential for appropriate management and reimbursement, as it informs treatment decisions and potential surgical interventions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of locations within the digestive system
  • Potential for malignant transformation
  • Need for precise documentation of tumor characteristics
  • Differentiation from malignant neoplasms

Audit Risk Factors

  • Inadequate documentation of the neoplasm's characteristics
  • Failure to specify the location of the neoplasm
  • Misclassification as malignant due to lack of clarity
  • Insufficient follow-up documentation for surveillance

Specialty Focus

Medical Specialties

Gastroenterology

Documentation Requirements

Detailed descriptions of the neoplasm's size, location, and any symptoms experienced by the patient.

Common Clinical Scenarios

Patients presenting with abdominal pain, gastrointestinal bleeding, or incidental findings on imaging.

Billing Considerations

Consideration of the patient's history of gastrointestinal disorders and previous neoplasms.

Surgery

Documentation Requirements

Operative reports detailing the excision of the neoplasm, including histopathological findings.

Common Clinical Scenarios

Surgical intervention for symptomatic benign neoplasms or those with potential for complications.

Billing Considerations

Documentation of the surgical approach and any complications encountered during the procedure.

Coding Guidelines

Inclusion Criteria

Use D13 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the neoplasm's location and characteristics

Exclusion Criteria

Do NOT use D13 When
  • Exclude malignant neoplasms and ensure that the diagnosis aligns with clinical findings

Related CPT Codes

45385CPT Code

Colonoscopy with removal of polyp

Clinical Scenario

Used when a benign polyp is identified and removed during a colonoscopy.

Documentation Requirements

Document the size, location, and histological findings of the polyp.

Specialty Considerations

Gastroenterologists should ensure that the findings are clearly documented in the operative report.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of benign neoplasms, improving the granularity of data collection and enhancing the ability to track outcomes and treatment efficacy.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of benign neoplasms, improving the granularity of data collection and enhancing the ability to track outcomes and treatment efficacy.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of benign neoplasms, improving the granularity of data collection and enhancing the ability to track outcomes and treatment efficacy.

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 difference between benign and malignant neoplasms?

Benign neoplasms are non-cancerous growths that do not invade surrounding tissues or metastasize, while malignant neoplasms are cancerous and can spread to other parts of the body. Accurate coding is essential to differentiate between the two.