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ICD-10 Guide
ICD-10 CodesD21.1

D21.1

Billable

Benign neoplasm of connective and other soft tissue of upper limb, including shoulder

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

Code Description

ICD-10 D21.1 is a billable code used to indicate a diagnosis of benign neoplasm of connective and other soft tissue of upper limb, including shoulder.

Key Diagnostic Point:

D21.1 refers to benign neoplasms that arise from connective tissues and other soft tissues located in the upper limb, including the shoulder. These neoplasms can include lipomas, fibromas, and other soft tissue tumors that are non-cancerous. Clinically, these tumors may present as palpable masses, often asymptomatic, but can cause discomfort or functional impairment depending on their size and location. Diagnosis typically involves imaging studies such as ultrasound or MRI, and histological examination may be required for definitive diagnosis. Management usually involves surgical excision, especially if the neoplasm is symptomatic or growing. Follow-up care is essential to monitor for recurrence, although benign neoplasms generally have a low risk of malignant transformation. The prognosis is typically excellent, with most patients experiencing complete resolution of symptoms post-surgery.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of benign neoplasms that can fall under this code
  • Need for precise documentation of tumor characteristics
  • Differentiation from malignant neoplasms
  • Potential for overlapping codes with similar conditions

Audit Risk Factors

  • Inadequate documentation of tumor size and location
  • Failure to specify the type of benign neoplasm
  • Misclassification of benign neoplasms as malignant
  • Lack of follow-up documentation post-surgery

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and pathology results.

Common Clinical Scenarios

Surgical excision of a lipoma in the upper arm or shoulder region.

Billing Considerations

Ensure clear documentation of the surgical approach and any complications.

Oncology

Documentation Requirements

Comprehensive patient history, imaging, and biopsy results.

Common Clinical Scenarios

Evaluation of a soft tissue mass to rule out malignancy.

Billing Considerations

Differentiation between benign and malignant neoplasms is critical for accurate coding.

Coding Guidelines

Inclusion Criteria

Use D21.1 When
  • According to ICD
  • 10 coding guidelines, D21
  • 1 should be used when the neoplasm is confirmed as benign through appropriate diagnostic measures
  • It is important to document the specific type of neoplasm and its anatomical location

Exclusion Criteria

Do NOT use D21.1 When
  • Exclusions include malignant neoplasms and conditions that do not involve connective or soft tissue

Related ICD-10 Codes

Related CPT Codes

11400CPT Code

Excision, benign lesion, face, ears, eyelids, scalp; excised diameter up to 4.0 cm

Clinical Scenario

Used when excising a benign neoplasm from the upper limb.

Documentation Requirements

Operative report detailing the excised lesion and its characteristics.

Specialty Considerations

Orthopedic surgeons should document the functional impact of the lesion.

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. D21.1 provides a clear distinction for benign tumors of the upper limb, which aids in clinical management and research.

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. D21.1 provides a clear distinction for benign tumors of the upper limb, which aids in clinical management and research.

Reimbursement & Billing Impact

reimbursement processes. D21.1 provides a clear distinction for benign tumors of the upper limb, which aids in clinical management 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 types of tumors are classified under D21.1?

D21.1 includes various benign tumors such as lipomas, fibromas, and other soft tissue tumors located in the upper limb and shoulder.

How do I differentiate between benign and malignant neoplasms?

Differentiation is typically made through imaging studies and histological examination of the tumor, with benign neoplasms being well-circumscribed and non-invasive.