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v1.0.0
ICD-10 Guide
ICD-10 CodesD40.0

D40.0

Billable

Neoplasm of uncertain behavior of prostate

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

Code Description

ICD-10 D40.0 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of prostate.

Key Diagnostic Point:

D40.0 refers to a neoplasm of uncertain behavior specifically located in the prostate gland. This classification is used when the neoplasm does not exhibit definitive characteristics of malignancy or benignity, making it challenging to predict its clinical course. Neoplasms of uncertain behavior can include atypical hyperplasia or low-grade tumors that may not yet meet the criteria for a definitive diagnosis of cancer. Surveillance is critical in managing these cases, as there is a potential for progression to malignancy. Regular monitoring through PSA levels, imaging studies, and biopsies may be necessary to assess any changes in the neoplasm's behavior. The clinical management of patients with D40.0 often involves a multidisciplinary approach, including urologists, oncologists, and primary care providers, to ensure comprehensive care and timely intervention if the neoplasm shows signs of progression.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Ambiguity in diagnosis due to uncertain behavior
  • Need for ongoing surveillance and monitoring
  • Potential for progression to malignancy requiring careful documentation
  • Variability in clinical presentation and management strategies

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document surveillance plans
  • Misclassification of neoplasm behavior
  • Lack of follow-up notes indicating monitoring

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed clinical notes on the nature of the neoplasm, results of imaging studies, and any biopsies performed.

Common Clinical Scenarios

Patients presenting with elevated PSA levels and subsequent biopsy results indicating atypical cells.

Billing Considerations

Urologists must ensure that all findings are clearly documented to support the diagnosis of uncertain behavior.

Oncology

Documentation Requirements

Comprehensive treatment plans, including surveillance strategies and any interventions considered.

Common Clinical Scenarios

Patients with a history of prostate neoplasms requiring ongoing monitoring for potential progression.

Billing Considerations

Oncologists should document any changes in the neoplasm's behavior and the rationale for treatment decisions.

Coding Guidelines

Inclusion Criteria

Use D40.0 When
  • According to ICD
  • 10 guidelines, D40
  • 0 should be used when the neoplasm's behavior is uncertain and does not fit into other specific categories
  • It is essential to document the clinical rationale for using this code, including any diagnostic tests performed

Exclusion Criteria

Do NOT use D40.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

55700CPT Code

Prostate biopsy

Clinical Scenario

Used when a biopsy is performed to evaluate a neoplasm of uncertain behavior.

Documentation Requirements

Document the indication for biopsy and findings.

Specialty Considerations

Urologists should ensure that the biopsy results are clearly linked to the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior. This specificity aids in better tracking and management of patients, improving clinical outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior. This specificity aids in better tracking and management of patients, improving clinical outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior. This specificity aids in better tracking and management of patients, improving clinical outcomes.

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 does 'neoplasm of uncertain behavior' mean?

It refers to a growth that does not clearly indicate whether it is benign or malignant, requiring careful monitoring and evaluation.