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ICD-10 Guide
ICD-10 CodesD43.1

D43.1

Billable

Neoplasm of uncertain behavior of brain, infratentorial

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

Code Description

ICD-10 D43.1 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of brain, infratentorial.

Key Diagnostic Point:

D43.1 refers to a neoplasm located in the infratentorial region of the brain that is classified as having uncertain behavior. This means that the tumor's potential for malignancy is not clearly defined, which can complicate treatment and management decisions. Infratentorial neoplasms typically include tumors located in the cerebellum and brainstem, which can affect vital functions such as coordination, balance, and autonomic processes. The uncertainty surrounding these tumors necessitates careful monitoring and evaluation, as they may exhibit benign characteristics but have the potential for malignant transformation. Surveillance strategies often involve regular imaging studies and neurological assessments to track any changes in tumor size or behavior. The management of these neoplasms may include surgical intervention, radiation therapy, or observation, depending on the tumor's characteristics and the patient's overall health. Accurate coding of D43.1 is crucial for appropriate treatment planning and resource allocation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in tumor behavior and potential for malignancy
  • Need for comprehensive documentation of imaging and clinical findings
  • Differentiation from other brain neoplasms with known behavior
  • Potential for changes in coding based on ongoing surveillance results

Audit Risk Factors

  • Inadequate documentation of tumor behavior and characteristics
  • Failure to update coding based on surveillance findings
  • Misclassification of tumor type or location
  • Lack of interdisciplinary notes in the medical record

Specialty Focus

Medical Specialties

Neurosurgery

Documentation Requirements

Detailed operative reports, imaging studies, and follow-up notes are essential for accurate coding.

Common Clinical Scenarios

Surgical resection of infratentorial tumors, post-operative complications, and follow-up imaging.

Billing Considerations

Ensure that all surgical interventions and their outcomes are clearly documented to support the coding.

Oncology

Documentation Requirements

Comprehensive treatment plans, pathology reports, and imaging results are necessary.

Common Clinical Scenarios

Management of patients with infratentorial tumors undergoing chemotherapy or radiation therapy.

Billing Considerations

Document the rationale for treatment decisions and any changes in tumor behavior over time.

Coding Guidelines

Inclusion Criteria

Use D43.1 When
  • According to the ICD
  • CM coding guidelines, D43
  • 1 should be used when the neoplasm is confirmed to be of uncertain behavior and located in the infratentorial region
  • Coders should ensure that the diagnosis is supported by appropriate clinical documentation and imaging studies

Exclusion Criteria

Do NOT use D43.1 When
  • Exclusion criteria include tumors with a definitive benign or malignant classification

Related ICD-10 Codes

Related CPT Codes

61510CPT Code

Craniotomy, excision of brain tumor

Clinical Scenario

Used when a patient with D43.1 undergoes surgical intervention for tumor resection.

Documentation Requirements

Operative report detailing the procedure, findings, and any complications.

Specialty Considerations

Neurosurgeons should ensure that all relevant details are captured in the operative report.

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. D43.1 provides a clear classification for infratentorial tumors, facilitating better tracking of patient outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior. D43.1 provides a clear classification for infratentorial tumors, facilitating better tracking of patient outcomes and resource allocation.

Reimbursement & Billing Impact

reimbursement and to ensure that the patient's care is appropriately managed.

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 D43.1?

Coding D43.1 is crucial for accurately representing the patient's diagnosis of an infratentorial neoplasm of uncertain behavior, which impacts treatment decisions and monitoring strategies.