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v1.0.0
ICD-10 Guide
ICD-10 CodesD13.1

D13.1

Billable

Benign neoplasm of stomach

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

Code Description

ICD-10 D13.1 is a billable code used to indicate a diagnosis of benign neoplasm of stomach.

Key Diagnostic Point:

Benign neoplasms of the stomach, classified under ICD-10 code D13.1, are non-cancerous tumors that can arise from various tissues within the gastric structure. These neoplasms may include gastric polyps, adenomas, and other benign growths that do not exhibit invasive characteristics. Clinically, patients may present with symptoms such as abdominal pain, nausea, or gastrointestinal bleeding, although many cases are asymptomatic and discovered incidentally during imaging or endoscopic procedures. Surveillance for benign neoplasms is crucial, as certain types, such as adenomatous polyps, may have a potential for malignant transformation over time. Regular monitoring through endoscopy is recommended, especially for patients with a history of gastric neoplasms or those exhibiting dysplastic changes. The management of benign gastric neoplasms often involves surveillance and, in some cases, surgical intervention if there is concern for malignancy or significant symptoms. Understanding the nature of these neoplasms is essential for appropriate coding and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between benign and malignant neoplasms
  • Need for precise documentation of tumor type and characteristics
  • Variability in clinical presentation and symptoms
  • Potential for malignant transformation requiring careful surveillance

Audit Risk Factors

  • Inadequate documentation of the neoplasm type
  • Failure to document surveillance or follow-up plans
  • Misclassification of benign neoplasms as malignant
  • Lack of clear clinical indications for procedures performed

Specialty Focus

Medical Specialties

Gastroenterology

Documentation Requirements

Detailed endoscopic findings, biopsy results, and follow-up plans.

Common Clinical Scenarios

Patients presenting with gastric polyps or incidental findings during endoscopy.

Billing Considerations

Ensure accurate documentation of the type of neoplasm and any dysplastic changes.

Surgery

Documentation Requirements

Operative reports detailing the excision of neoplasms and histopathology results.

Common Clinical Scenarios

Surgical intervention for symptomatic benign neoplasms or those with dysplastic features.

Billing Considerations

Document the rationale for surgical intervention and any findings during the procedure.

Coding Guidelines

Inclusion Criteria

Use D13.1 When
  • According to official coding guidelines, D13
  • 1 should be used when a benign neoplasm of the stomach is confirmed through diagnostic imaging or histopathological examination

Exclusion Criteria

Do NOT use D13.1 When
  • Exclusion criteria include any neoplasm that is classified as malignant or uncertain behavior

Related ICD-10 Codes

Related CPT Codes

43239CPT Code

Esophagogastroduodenoscopy, flexible, transoral; diagnostic

Clinical Scenario

Used for surveillance of benign gastric neoplasms.

Documentation Requirements

Document findings, biopsies taken, and any interventions performed.

Specialty Considerations

Gastroenterologists should ensure thorough documentation of all findings.

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 accuracy of data collection and reimbursement processes. D13.1 provides a clear distinction from malignant neoplasms, which is crucial for patient management and treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of benign neoplasms, improving the accuracy of data collection and reimbursement processes. D13.1 provides a clear distinction from malignant neoplasms, which is crucial for patient management and treatment planning.

Reimbursement & Billing Impact

reimbursement processes. D13.1 provides a clear distinction from malignant neoplasms, which is crucial for patient management and treatment planning.

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 for treatment and billing purposes.