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ICD-10 Guide
ICD-10 CodesD13.6

D13.6

Billable

Benign neoplasm of pancreas

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

Code Description

ICD-10 D13.6 is a billable code used to indicate a diagnosis of benign neoplasm of pancreas.

Key Diagnostic Point:

Benign neoplasms of the pancreas are non-cancerous tumors that can arise from various types of pancreatic tissue, including endocrine and exocrine components. These neoplasms may present as solid masses or cystic lesions and can vary in size. Common types include insulinomas, gastrinomas, and serous cystadenomas. While benign, these tumors can lead to symptoms such as abdominal pain, jaundice, or pancreatitis due to their size or location. Diagnosis typically involves imaging studies like CT scans or MRIs, and sometimes biopsy. Management may include surgical resection, especially if the neoplasm is symptomatic or has the potential for malignant transformation. Regular surveillance is essential to monitor for any changes in size or characteristics that may indicate a risk of malignancy. Although benign, the potential for malignant transformation, particularly in certain types of neoplasms, necessitates careful follow-up and management strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation between benign and malignant neoplasms
  • Variability in presentation and symptoms
  • Need for imaging and potential biopsy documentation
  • Potential for malignant transformation requiring ongoing surveillance

Audit Risk Factors

  • Inadequate documentation of imaging studies
  • Failure to document the benign nature of the neoplasm
  • Lack of follow-up notes indicating surveillance
  • Misclassification of benign neoplasm as malignant

Specialty Focus

Medical Specialties

Gastroenterology

Documentation Requirements

Detailed imaging reports, biopsy results, and treatment plans must be documented.

Common Clinical Scenarios

Patients presenting with abdominal pain or jaundice due to pancreatic neoplasms.

Billing Considerations

Ensure that the nature of the neoplasm (benign vs malignant) is clearly documented.

Surgery

Documentation Requirements

Operative reports detailing the surgical approach and findings.

Common Clinical Scenarios

Surgical resection of symptomatic benign pancreatic tumors.

Billing Considerations

Document the rationale for surgery and any findings that may indicate malignancy.

Coding Guidelines

Inclusion Criteria

Use D13.6 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the neoplasm's benign nature
  • Include any relevant imaging or biopsy results to support the diagnosis

Exclusion Criteria

Do NOT use D13.6 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

48100CPT Code

Pancreatectomy, partial

Clinical Scenario

Used when a benign pancreatic neoplasm is surgically removed.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Ensure that the indication for surgery is clearly documented.

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.

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.

Reimbursement & Billing Impact

reimbursement processes.

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.