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ICD-10 Guide
ICD-10 CodesD41.20

D41.20

Billable

Neoplasm of uncertain behavior of unspecified ureter

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

Code Description

ICD-10 D41.20 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of unspecified ureter.

Key Diagnostic Point:

Neoplasms of uncertain behavior are tumors that do not fit neatly into benign or malignant categories. The unspecified ureter designation indicates that the neoplasm is located in the ureter but lacks sufficient information to determine its precise nature. These neoplasms may exhibit atypical cellular characteristics, raising concerns about their potential for progression to malignancy. Surveillance is critical, as these tumors can vary widely in behavior, with some remaining stable while others may progress. Regular imaging and clinical evaluations are essential to monitor changes in size or characteristics, which may indicate a shift towards malignancy. The management of these neoplasms often involves a multidisciplinary approach, including urologists and oncologists, to determine the best course of action, which may range from active surveillance to surgical intervention depending on the tumor's behavior and patient factors.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Uncertainty in behavior classification
  • Need for detailed clinical documentation
  • Variability in tumor characteristics
  • Potential for progression to malignancy

Audit Risk Factors

  • Inadequate documentation of tumor characteristics
  • Failure to specify the location of the neoplasm
  • Lack of follow-up notes on surveillance
  • Misclassification of behavior as benign or malignant

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed imaging reports, biopsy results, and clinical notes on tumor behavior.

Common Clinical Scenarios

Patients presenting with hematuria or urinary obstruction due to ureteral neoplasms.

Billing Considerations

Urologists must document the rationale for surveillance versus intervention clearly.

Oncology

Documentation Requirements

Comprehensive treatment plans, pathology reports, and follow-up assessments.

Common Clinical Scenarios

Patients with a history of neoplasms undergoing monitoring for potential progression.

Billing Considerations

Oncologists should ensure that the uncertainty of behavior is well-documented to justify coding.

Coding Guidelines

Inclusion Criteria

Use D41.20 When
  • According to ICD
  • 10 guidelines, neoplasms of uncertain behavior should be coded based on the most specific information available
  • If the neoplasm's behavior is uncertain, it should be documented thoroughly to justify the use of D41

Exclusion Criteria

Do NOT use D41.20 When
  • Exclusions include neoplasms that can be definitively classified as benign or malignant

Related ICD-10 Codes

Related CPT Codes

52000CPT Code

Cystoscopy

Clinical Scenario

Used for direct visualization of the ureter and potential biopsy.

Documentation Requirements

Document indication for cystoscopy and findings.

Specialty Considerations

Urologists should ensure that the procedure is justified based on clinical findings.

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 these conditions, improving patient care and 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 these conditions, improving patient care and 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 these conditions, improving patient care and 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 tumors that cannot be definitively classified as benign or malignant based on available clinical and pathological information.

How often should patients with D41.20 be monitored?

Patients should be monitored regularly, with follow-up imaging and clinical evaluations based on the tumor's characteristics and any changes observed.