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v1.0.0
ICD-10 Guide
ICD-10 CodesD42.0

D42.0

Billable

Neoplasm of uncertain behavior of cerebral meninges

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

Code Description

ICD-10 D42.0 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of cerebral meninges.

Key Diagnostic Point:

D42.0 refers to a neoplasm of uncertain behavior located in the cerebral meninges, which are the protective membranes covering the brain and spinal cord. These neoplasms can be classified as either benign or malignant, but due to their uncertain behavior, they do not fit neatly into either category. Clinically, these tumors may present with symptoms such as headaches, seizures, or neurological deficits, depending on their size and location. Imaging studies, particularly MRI, are crucial for diagnosis, as they help delineate the tumor's characteristics and its effect on surrounding brain structures. The management of these neoplasms often involves a multidisciplinary approach, including neurosurgery, oncology, and radiology, to determine the best course of action, which may range from observation to surgical intervention. Surveillance is critical, as these tumors have the potential for progression, necessitating regular follow-up imaging and clinical assessments to monitor for changes in behavior or growth.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Uncertain behavior classification complicates coding.
  • Requires detailed documentation of clinical findings.
  • Differentiation from other neoplasms can be challenging.
  • Potential for progression necessitates ongoing surveillance.

Audit Risk Factors

  • Inadequate documentation of tumor behavior.
  • Failure to document imaging findings.
  • Lack of follow-up notes indicating surveillance.
  • Misclassification of benign versus malignant behavior.

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with headaches, seizures, or neurological deficits.

Billing Considerations

Ensure clear documentation of symptoms and imaging results to support the diagnosis.

Neurosurgery

Documentation Requirements

Surgical reports, pathology results, and follow-up care notes.

Common Clinical Scenarios

Surgical intervention for symptomatic neoplasms or those showing progression.

Billing Considerations

Document the rationale for surgical intervention and any complications.

Coding Guidelines

Inclusion Criteria

Use D42.0 When
  • According to ICD
  • 10 coding guidelines, D42
  • 0 should be used when the neoplasm's behavior is uncertain and specific documentation supports this classification
  • It is important to differentiate from codes for benign or malignant neoplasms

Exclusion Criteria

Do NOT use D42.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

61510CPT Code

Craniotomy for excision of brain tumor

Clinical Scenario

Used when surgical intervention is required for symptomatic neoplasms.

Documentation Requirements

Surgical reports detailing the procedure and findings.

Specialty Considerations

Neurosurgeons must document the rationale for surgery and any complications.

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

reimbursement and to avoid denials.

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 'uncertain behavior' mean in the context of D42.0?

Uncertain behavior indicates that the neoplasm does not clearly fit into benign or malignant categories, necessitating careful monitoring and evaluation.