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ICD-10 Guide
ICD-10 CodesC38.4

C38.4

Billable

Malignant neoplasm of pleura

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

Code Description

ICD-10 C38.4 is a billable code used to indicate a diagnosis of malignant neoplasm of pleura.

Key Diagnostic Point:

Malignant neoplasm of the pleura primarily refers to tumors that arise from the pleural lining of the lungs, most commonly associated with mesothelioma, which is linked to asbestos exposure. This neoplasm can present with symptoms such as pleuritic chest pain, dyspnea, and cough. Diagnosis typically involves imaging studies like chest X-rays or CT scans, followed by biopsy for histological confirmation. The pleura is a critical structure in the thoracic cavity, and malignancies here can lead to significant complications, including pleural effusion and respiratory distress. Treatment options may include surgical resection, chemotherapy, and radiation therapy, depending on the stage and extent of the disease. Surgical considerations are paramount, as complete resection can be challenging due to the tumor's invasive nature and proximity to vital thoracic structures. Multidisciplinary management is often required, involving oncologists, thoracic surgeons, and palliative care specialists to optimize patient outcomes.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiation between primary and secondary pleural malignancies
  • Need for precise staging and grading of the tumor
  • Variability in treatment approaches based on tumor type and location
  • Potential for associated conditions like pleural effusion or lung metastasis

Audit Risk Factors

  • Inadequate documentation of the tumor's origin and type
  • Failure to document staging and grading accurately
  • Misclassification of pleural effusion as a primary diagnosis
  • Lack of clarity on previous asbestos exposure history

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 pleural mesothelioma, treatment planning for chemotherapy or radiation.

Billing Considerations

Ensure accurate staging and grading of the tumor for appropriate coding.

Thoracic Surgery

Documentation Requirements

Operative reports, pre-operative assessments, and post-operative follow-ups are essential.

Common Clinical Scenarios

Surgical resection of pleural tumors, management of pleural effusions.

Billing Considerations

Document the extent of resection and any complications encountered during surgery.

Coding Guidelines

Inclusion Criteria

Use C38.4 When
  • According to ICD
  • 10 guidelines, C38
  • 4 should be used when the malignant neoplasm is confirmed to be of the pleura
  • It is essential to document the specific type of malignancy and any associated conditions

Exclusion Criteria

Do NOT use C38.4 When
  • Exclusions include benign neoplasms and metastatic disease not originating from the pleura

Related ICD-10 Codes

Related CPT Codes

32405CPT Code

Pleurectomy

Clinical Scenario

Performed for resection of malignant pleural tumors.

Documentation Requirements

Operative report detailing the extent of resection and findings.

Specialty Considerations

Thoracic surgery documentation must include pre-operative assessments.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of pleural malignancies, improving the accuracy of data collection and reimbursement processes. C38.4 provides a distinct code for malignant neoplasms of the pleura, enhancing clarity in patient records and treatment plans.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pleural malignancies, improving the accuracy of data collection and reimbursement processes. C38.4 provides a distinct code for malignant neoplasms of the pleura, enhancing clarity in patient records and treatment plans.

Reimbursement & Billing Impact

reimbursement processes. C38.4 provides a distinct code for malignant neoplasms of the pleura, enhancing clarity in patient records and treatment plans.

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 primary cause of malignant neoplasm of the pleura?

The primary cause is often exposure to asbestos, which is linked to the development of mesothelioma, the most common type of malignant pleural neoplasm.