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v1.0.0
ICD-10 Guide
ICD-10 CodesD43.0

D43.0

Billable

Neoplasm of uncertain behavior of brain, supratentorial

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

Code Description

ICD-10 D43.0 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of brain, supratentorial.

Key Diagnostic Point:

D43.0 refers to a neoplasm located in the supratentorial region of the brain that is classified as having uncertain behavior. This means that the tumor does not exhibit clear characteristics of benign or malignant behavior, making it challenging to predict its clinical course. These neoplasms can arise from various cell types, including glial cells, and may present with symptoms such as headaches, seizures, or neurological deficits depending on their size and location. Surveillance is critical for these tumors, as they may exhibit slow growth or potential for malignant transformation over time. Regular imaging studies, such as MRI or CT scans, are essential for monitoring changes in size or characteristics of the neoplasm. The management of these tumors 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.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and symptoms
  • Need for precise documentation of tumor characteristics
  • Potential for progression to malignancy
  • Differentiation from other brain neoplasms

Audit Risk Factors

  • Inadequate documentation of tumor behavior
  • Failure to update coding based on imaging results
  • Misclassification of tumor type
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Neurosurgery

Documentation Requirements

Detailed operative reports and imaging studies must be documented.

Common Clinical Scenarios

Surgical intervention for tumor resection or biopsy.

Billing Considerations

Ensure clear documentation of tumor characteristics and surgical findings.

Oncology

Documentation Requirements

Comprehensive treatment plans and follow-up notes are necessary.

Common Clinical Scenarios

Management of tumor growth with chemotherapy or radiation.

Billing Considerations

Document any changes in tumor behavior and response to treatment.

Coding Guidelines

Inclusion Criteria

Use D43.0 When
  • According to ICD
  • 10 guidelines, D43
  • 0 should be used when the neoplasm is confirmed to be of uncertain behavior and located in the supratentorial region
  • It is essential to document the specific location and characteristics of the tumor

Exclusion Criteria

Do NOT use D43.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

61510CPT Code

Craniotomy, excision of brain tumor

Clinical Scenario

Used when a patient with D43.0 undergoes surgical intervention.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Neurosurgeons must document the tumor's characteristics 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, which aids in better tracking and management of these conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior, which aids in better tracking and management of these conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior, which aids in better tracking and management of these conditions.

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 D43.0?

Uncertain behavior indicates that the tumor does not clearly exhibit characteristics of being benign or malignant, making it difficult to predict its clinical course.