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v1.0.0
ICD-10 Guide
ICD-10 CodesC49.1

C49.1

Billable

Malignant neoplasm of connective and soft tissue of upper limb, including shoulder

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

Code Description

ICD-10 C49.1 is a billable code used to indicate a diagnosis of malignant neoplasm of connective and soft tissue of upper limb, including shoulder.

Key Diagnostic Point:

C49.1 refers to malignant neoplasms that arise from connective and soft tissues in the upper limb, including the shoulder. These tumors can include a variety of soft tissue sarcomas, which are rare but aggressive cancers that can originate from muscle, fat, nerves, fibrous tissues, blood vessels, or deep skin tissues. The clinical presentation may vary, but common symptoms include a palpable mass, pain, swelling, or functional impairment of the affected limb. Diagnosis typically involves imaging studies such as MRI or CT scans, followed by a biopsy to confirm malignancy and histological type. Grading of soft tissue sarcomas is crucial, as it helps determine prognosis and treatment options. Multidisciplinary management is essential, involving surgical oncologists, medical oncologists, radiation oncologists, and pathologists to ensure comprehensive care. Treatment may include surgical resection, chemotherapy, and radiation therapy, tailored to the tumor's size, location, and grade.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of histological types of soft tissue sarcomas
  • Need for precise grading and staging
  • Multidisciplinary approach to treatment
  • Variability in clinical presentation and symptoms

Audit Risk Factors

  • Inadequate documentation of tumor type and grade
  • Failure to document multidisciplinary treatment approaches
  • Misclassification of benign versus malignant tumors
  • Lack of follow-up documentation post-treatment

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, treatment plans, and follow-up notes.

Common Clinical Scenarios

Diagnosis and management of soft tissue sarcomas, treatment planning, and follow-up care.

Billing Considerations

Ensure accurate coding of tumor type and grade, and document all multidisciplinary interventions.

Surgery

Documentation Requirements

Operative reports, pre-operative assessments, and post-operative follow-up notes.

Common Clinical Scenarios

Surgical resection of soft tissue sarcomas, management of surgical complications.

Billing Considerations

Document the extent of resection and any adjuvant therapies planned.

Coding Guidelines

Inclusion Criteria

Use C49.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the tumor's location, type, and grade
  • Include relevant clinical information that supports the diagnosis and treatment plan

Exclusion Criteria

Do NOT use C49.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

19301CPT Code

Mastectomy, partial

Clinical Scenario

Used in cases where sarcoma involves breast tissue.

Documentation Requirements

Operative report detailing the extent of resection.

Specialty Considerations

Oncology and surgical documentation must align for accurate coding.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of soft tissue sarcomas, improving the accuracy of data collection and reimbursement processes. C49.1 provides granularity that was not available in ICD-9, facilitating better tracking of treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of soft tissue sarcomas, improving the accuracy of data collection and reimbursement processes. C49.1 provides granularity that was not available in ICD-9, facilitating better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

reimbursement processes. C49.1 provides granularity that was not available in ICD-9, facilitating better tracking of treatment outcomes and resource allocation.

Resources

Clinical References

  • •
    American Cancer Society - Soft Tissue Sarcoma

Coding & Billing References

  • •
    American Cancer Society - Soft Tissue Sarcoma

Frequently Asked Questions

What is the significance of grading in soft tissue sarcomas?

Grading is crucial as it helps predict the tumor's behavior, guides treatment decisions, and informs prognosis. High-grade tumors are more aggressive and may require more intensive treatment.