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ICD-10 Guide
ICD-10 CodesC25.2

C25.2

Billable

Malignant neoplasm of tail of pancreas

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

Code Description

ICD-10 C25.2 is a billable code used to indicate a diagnosis of malignant neoplasm of tail of pancreas.

Key Diagnostic Point:

Malignant neoplasm of the tail of the pancreas is a type of pancreatic cancer that arises from the cells in the tail region of the pancreas. This cancer is often asymptomatic in its early stages, leading to late diagnosis when the disease is more advanced. Symptoms may include abdominal pain, weight loss, jaundice, and changes in stool. The staging of pancreatic cancer is particularly challenging due to the pancreas's deep location in the abdomen and the tendency for the cancer to metastasize early. The most common biomarker used in the diagnosis and monitoring of pancreatic cancer is CA 19-9, which can help assess treatment response and disease progression. Unfortunately, the prognosis for patients diagnosed with malignant neoplasm of the tail of the pancreas is generally poor, with a five-year survival rate often below 10%. This is primarily due to late-stage diagnosis and the aggressive nature of the disease, which often spreads to nearby organs and lymph nodes before detection.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Late-stage diagnosis due to asymptomatic nature
  • Variability in staging and treatment response
  • Use of CA 19-9 as a non-specific biomarker
  • Differentiation from other pancreatic tumors

Audit Risk Factors

  • Inadequate documentation of staging
  • Failure to document CA 19-9 levels
  • Misclassification of tumor location
  • Lack of clarity in treatment plans

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans must be documented.

Common Clinical Scenarios

Patients presenting with abdominal pain and weight loss, diagnosed via imaging and biopsy.

Billing Considerations

Ensure accurate staging and documentation of CA 19-9 levels for treatment monitoring.

Gastroenterology

Documentation Requirements

Endoscopic findings, imaging results, and biopsy reports are essential.

Common Clinical Scenarios

Patients with obstructive jaundice or pancreatitis symptoms requiring further evaluation.

Billing Considerations

Document any endoscopic interventions and their outcomes.

Coding Guidelines

Inclusion Criteria

Use C25.2 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the tumor's location, staging, and any associated symptoms
  • Include any relevant imaging or pathology reports to support the diagnosis

Exclusion Criteria

Do NOT use C25.2 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

49320CPT Code

Laparoscopic exploration of the abdomen

Clinical Scenario

Used when a patient with suspected pancreatic cancer undergoes exploratory surgery.

Documentation Requirements

Document findings, any biopsies taken, and the rationale for the procedure.

Specialty Considerations

Oncologists should ensure that all findings are clearly documented for staging purposes.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of pancreatic cancers, improving the accuracy of data collection and reimbursement processes. C25.2 provides a clear distinction for malignant neoplasms of the tail of the pancreas, which was less specific in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pancreatic cancers, improving the accuracy of data collection and reimbursement processes. C25.2 provides a clear distinction for malignant neoplasms of the tail of the pancreas, which was less specific in ICD-9.

Reimbursement & Billing Impact

reimbursement processes. C25.2 provides a clear distinction for malignant neoplasms of the tail of the pancreas, which was less specific in ICD-9.

Resources

Clinical References

  • •
    American Cancer Society - Pancreatic Cancer

Coding & Billing References

  • •
    American Cancer Society - Pancreatic Cancer

Frequently Asked Questions

What are the common symptoms of malignant neoplasm of the tail of the pancreas?

Common symptoms include abdominal pain, unexplained weight loss, jaundice, and changes in stool color. However, many patients may be asymptomatic in the early stages.