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v1.0.0
ICD-10 Guide
ICD-10 CodesR97.8

R97.8

Other abnormal tumor markers

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R97.8 is a billable code used to indicate a diagnosis of other abnormal tumor markers.

Key Diagnostic Point:

The ICD-10 code R97.8 is used to classify abnormal tumor markers that do not fall under specific categories defined by other codes. Tumor markers are substances, often proteins, produced by cancer cells or by the body in response to cancer. They can be detected in blood, urine, or tissues and are used primarily for diagnosis, monitoring treatment response, and assessing recurrence. Abnormal levels of tumor markers can indicate various malignancies or other conditions, but the presence of these markers alone is not diagnostic of cancer. Common tumor markers include CA-125, PSA, and CEA, among others. The interpretation of abnormal results requires careful clinical correlation and consideration of the patient's overall clinical picture. This code is particularly relevant when the specific tumor marker is not classified elsewhere, necessitating a broader categorization for coding purposes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of tumor markers and their clinical implications
  • Need for correlation with clinical findings and other diagnostic tests
  • Potential for overlapping symptoms with other conditions
  • Documentation requirements for specificity

Audit Risk Factors

  • Inadequate documentation linking abnormal markers to clinical findings
  • Misinterpretation of lab results leading to incorrect coding
  • Failure to specify the type of tumor marker when applicable
  • Coding without sufficient clinical context

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed clinical history, lab results, and correlation with physical examination findings.

Common Clinical Scenarios

Patients presenting with abnormal lab results during routine check-ups or follow-ups for known malignancies.

Billing Considerations

Ensure that the abnormal marker is documented in the context of the patient's overall health status and any ongoing treatment.

Emergency Medicine

Documentation Requirements

Acute care documentation must include immediate lab results and any relevant history.

Common Clinical Scenarios

Patients presenting with acute symptoms that may correlate with abnormal tumor markers, such as pain or unexplained weight loss.

Billing Considerations

Rapid assessment and documentation are crucial; ensure that abnormal findings are linked to the presenting complaint.

Coding Guidelines

Inclusion Criteria

Use R97.8 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the specific tumor marker is not classified elsewhere
  • Document the clinical context and rationale for testing

Exclusion Criteria

Do NOT use R97.8 When
No specific exclusions found.

Related CPT Codes

84153CPT Code

Tumor marker test

Clinical Scenario

When a tumor marker test is performed to evaluate a patient's cancer status.

Documentation Requirements

Document the specific tumor marker tested and the reason for testing.

Specialty Considerations

Oncology practices may frequently order these tests, requiring precise documentation.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of abnormal tumor markers, improving the granularity of data collection and analysis in oncology.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of abnormal tumor markers, improving the granularity of data collection and analysis in oncology.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of abnormal tumor markers, improving the granularity of data collection and analysis in oncology.

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

When should I use R97.8?

Use R97.8 when a patient has abnormal tumor markers that do not fit into more specific categories. Ensure that there is adequate documentation linking the abnormal markers to the patient's clinical condition.