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v1.0.0
ICD-10 Guide
ICD-10 CodesC34.3

C34.3

Billable

Malignant neoplasm of lower lobe, bronchus or lung

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

Code Description

ICD-10 C34.3 is a billable code used to indicate a diagnosis of malignant neoplasm of lower lobe, bronchus or lung.

Key Diagnostic Point:

C34.3 refers to malignant neoplasms located specifically in the lower lobe of the bronchus or lung. Lung cancer is a leading cause of cancer-related mortality worldwide, with the majority of cases being attributed to smoking. The disease can present in various forms, including non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), with NSCLC being the most prevalent. Staging of lung cancer is critical for determining prognosis and treatment options, typically classified using the TNM system (Tumor, Node, Metastasis). Molecular markers such as EGFR mutations, ALK rearrangements, and PD-L1 expression are increasingly important in guiding targeted therapies and immunotherapies. Treatment algorithms may include surgical resection, chemotherapy, radiation therapy, and targeted therapies, depending on the stage and histological type of the cancer. Accurate coding of C34.3 requires thorough documentation of the tumor's location, histology, and any relevant patient history, particularly smoking status, which is a significant risk factor for lung cancer.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of histological types (NSCLC vs. SCLC)
  • Need for precise staging information
  • Documentation of molecular markers
  • Variability in treatment protocols

Audit Risk Factors

  • Inadequate documentation of smoking history
  • Failure to document staging details
  • Missing molecular marker information
  • Incorrect assignment of primary site

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Diagnosis and management of lung cancer, staging workups, and treatment planning.

Billing Considerations

Ensure all relevant molecular testing results are included in the documentation.

Pulmonology

Documentation Requirements

Pulmonary function tests, imaging results, and smoking history must be documented.

Common Clinical Scenarios

Evaluation of lung nodules, management of lung cancer patients, and pre-operative assessments.

Billing Considerations

Document any comorbid conditions that may affect treatment decisions.

Coding Guidelines

Inclusion Criteria

Use C34.3 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the primary site, histology, and staging
  • Include any relevant patient history, particularly smoking status, and document any molecular testing results

Exclusion Criteria

Do NOT use C34.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

32551CPT Code

Thoracentesis, needle drainage of pleural effusion

Clinical Scenario

Used in patients with lung cancer presenting with pleural effusion.

Documentation Requirements

Document indication for procedure and findings.

Specialty Considerations

Pulmonologists should ensure proper imaging guidance is documented.

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 data accuracy and enabling better tracking of treatment outcomes and epidemiology.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of lung cancer, improving data accuracy and enabling better tracking of treatment outcomes and epidemiology.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of lung cancer, improving data accuracy and enabling better tracking of treatment outcomes and epidemiology.

Resources

Clinical References

  • •
    American Cancer Society - Lung Cancer

Coding & Billing References

  • •
    American Cancer Society - Lung Cancer

Frequently Asked Questions

What is the significance of staging in lung cancer coding?

Staging is crucial as it determines treatment options and prognosis. Accurate coding requires detailed documentation of the stage at diagnosis.