ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesD42.1

D42.1

Billable

Neoplasm of uncertain behavior of spinal meninges

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

Code Description

ICD-10 D42.1 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of spinal meninges.

Key Diagnostic Point:

D42.1 refers to a neoplasm of uncertain behavior located in the spinal meninges, which are the protective membranes covering the brain and spinal cord. These neoplasms can be classified as either benign or malignant, but their uncertain behavior indicates that their potential for progression or malignancy is not clearly defined. Clinically, patients may present with symptoms such as back pain, neurological deficits, or signs of increased intracranial pressure. Diagnosis typically involves imaging studies like MRI or CT scans, which can help visualize the mass and its effects on surrounding structures. Biopsy may be necessary to determine the histological nature of the neoplasm. Surveillance is crucial, as these neoplasms can exhibit unpredictable growth patterns, necessitating regular follow-up imaging and clinical assessments to monitor for any changes in behavior or symptoms. The management of these neoplasms may vary from observation to surgical intervention, depending on the individual case and the clinical judgment of the healthcare provider.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Uncertainty in behavior classification (benign vs malignant)
  • Need for comprehensive imaging and potential biopsy
  • Variability in clinical presentation and symptoms
  • Potential for progression requiring ongoing surveillance

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document imaging results and follow-up plans
  • Misclassification of neoplasm behavior
  • Lack of clear treatment plans or rationale for surveillance

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological assessments, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with unexplained neurological symptoms, requiring imaging and potential biopsy.

Billing Considerations

Ensure thorough documentation of neurological deficits and follow-up plans for monitoring.

Neurosurgery

Documentation Requirements

Surgical notes, imaging studies, and pathology reports.

Common Clinical Scenarios

Surgical intervention for symptomatic neoplasms or those showing signs of progression.

Billing Considerations

Document the rationale for surgical intervention and any complications encountered.

Coding Guidelines

Inclusion Criteria

Use D42.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the neoplasm's behavior and any associated symptoms
  • Include relevant imaging and treatment details to support the diagnosis

Exclusion Criteria

Do NOT use D42.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

63030CPT Code

Laminectomy, facetectomy, and/or foraminotomy

Clinical Scenario

Used when surgical intervention is required for symptomatic neoplasms.

Documentation Requirements

Surgical notes 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, enhancing the ability to track and manage these conditions effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior, enhancing the ability to track and manage these conditions effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior, enhancing the ability to track and manage these conditions effectively.

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 significance of coding D42.1?

Coding D42.1 is crucial for accurately capturing the nature of spinal neoplasms that are not definitively benign or malignant, allowing for appropriate management and surveillance.