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ICD-10 Guide
ICD-10 CodesC34.11

C34.11

Billable

Malignant neoplasm of upper lobe, right bronchus or lung

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

Code Description

ICD-10 C34.11 is a billable code used to indicate a diagnosis of malignant neoplasm of upper lobe, right bronchus or lung.

Key Diagnostic Point:

C34.11 refers to a malignant neoplasm located in the upper lobe of the right bronchus or lung. This diagnosis is commonly associated with lung cancer, which is characterized by uncontrolled cell growth in lung tissues. The primary risk factor for lung cancer is a history of smoking, with both active and passive exposure contributing significantly to the disease's development. Staging of lung cancer is crucial for determining treatment options and prognosis, typically classified using the TNM system, which assesses tumor size (T), lymph node involvement (N), and metastasis (M). Molecular markers, such as EGFR mutations and ALK rearrangements, play a vital role in personalizing treatment, guiding the use of targeted therapies. Treatment algorithms often include a combination of surgery, chemotherapy, radiation therapy, and immunotherapy, depending on the stage and specific characteristics of the tumor. Accurate coding for C34.11 requires comprehensive documentation of the patient's smoking history, staging details, and any molecular testing results to ensure appropriate treatment and reimbursement.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for precise staging information (TNM classification)
  • Documentation of smoking history and risk factors
  • Inclusion of molecular markers for targeted therapy
  • Differentiation from other lung cancer types

Audit Risk Factors

  • Incomplete documentation of staging
  • Lack of smoking history details
  • Failure to document molecular testing results
  • Inaccurate coding of metastasis

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Initial diagnosis of lung cancer, staging workup, and treatment planning.

Billing Considerations

Ensure all molecular testing results are documented to support targeted therapy coding.

Pulmonology

Documentation Requirements

Pulmonary function tests, imaging, and smoking history.

Common Clinical Scenarios

Evaluation of lung nodules, management of lung cancer patients, and follow-up care.

Billing Considerations

Document any respiratory symptoms and their relation to the malignancy.

Coding Guidelines

Inclusion Criteria

Use C34.11 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the primary site, laterality, and any associated conditions
  • Include staging information and molecular markers when applicable

Exclusion Criteria

Do NOT use C34.11 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

32405CPT Code

Video-assisted thoracoscopic lobectomy

Clinical Scenario

Used for surgical resection of the right upper lobe tumor.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Oncology and thoracic surgery documentation must align with coding.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of lung cancer, improving the accuracy of data collection and reimbursement processes. C34.11 provides granularity that was not available in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of lung cancer, improving the accuracy of data collection and reimbursement processes. C34.11 provides granularity that was not available in ICD-9.

Reimbursement & Billing Impact

reimbursement processes. C34.11 provides granularity that was not available in ICD-9.

Resources

Clinical References

  • •
    American Cancer Society - Lung Cancer

Coding & Billing References

  • •
    American Cancer Society - Lung Cancer

Frequently Asked Questions

What is the significance of molecular markers in lung cancer coding?

Molecular markers are crucial for determining targeted therapies and must be documented to support the coding of lung cancer accurately. They influence treatment decisions and can impact reimbursement.