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ICD-10 Guide
ICD-10 CodesC49.4

C49.4

Billable

Malignant neoplasm of connective and soft tissue of abdomen

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

Code Description

ICD-10 C49.4 is a billable code used to indicate a diagnosis of malignant neoplasm of connective and soft tissue of abdomen.

Key Diagnostic Point:

C49.4 refers to malignant neoplasms originating from connective and soft tissues located in the abdominal region. These tumors, commonly known as soft tissue sarcomas, can arise from various tissues including fat, muscle, nerves, fibrous tissues, and blood vessels. Soft tissue sarcomas are relatively rare, accounting for approximately 1% of all adult cancers. They can be classified into numerous subtypes based on the tissue of origin, with common types including liposarcoma, leiomyosarcoma, and synovial sarcoma. Grading of these tumors is crucial as it helps determine the aggressiveness of the cancer and guides treatment decisions. The grading system typically ranges from low-grade (well-differentiated) to high-grade (poorly differentiated), with higher grades indicating a more aggressive disease course. Multidisciplinary management is essential for optimal outcomes, involving surgical resection, radiation therapy, and chemotherapy as appropriate. Accurate coding for C49.4 requires comprehensive documentation of the tumor type, grade, and treatment plan, as well as any relevant patient history.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of soft tissue sarcoma subtypes requiring specific documentation.
  • Need for precise grading information to determine treatment and prognosis.
  • Potential for overlapping symptoms with benign conditions.
  • Variability in treatment approaches based on tumor location and grade.

Audit Risk Factors

  • Inadequate documentation of tumor grade and subtype.
  • Failure to capture multidisciplinary treatment approaches.
  • Misclassification of tumor location or type.
  • Lack of clarity in pathology reports.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Diagnosis and management of soft tissue sarcomas, including staging and treatment response.

Billing Considerations

Ensure accurate documentation of tumor grade and subtype for appropriate coding.

Surgery

Documentation Requirements

Operative reports detailing tumor resection and margins.

Common Clinical Scenarios

Surgical intervention for soft tissue sarcomas, including limb-sparing procedures.

Billing Considerations

Document surgical margins and any complications to support coding.

Coding Guidelines

Inclusion Criteria

Use C49.4 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the tumor's location, type, and grade
  • Include any relevant staging information and treatment plans

Exclusion Criteria

Do NOT use C49.4 When
  • Exclude benign tumors and ensure that the diagnosis is confirmed by pathology

Related ICD-10 Codes

Related CPT Codes

38542CPT Code

Excision of soft tissue tumor

Clinical Scenario

Used when a patient undergoes surgical excision of a soft tissue sarcoma.

Documentation Requirements

Operative report detailing the tumor size, location, and margins.

Specialty Considerations

Ensure the surgical specialty is noted 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. C49.4 provides a clear distinction for abdominal soft tissue malignancies, which aids in research and treatment planning.

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. C49.4 provides a clear distinction for abdominal soft tissue malignancies, which aids in research and treatment planning.

Reimbursement & Billing Impact

reimbursement processes. C49.4 provides a clear distinction for abdominal soft tissue malignancies, which aids in research and treatment planning.

Resources

Clinical References

  • •
    American Cancer Society - Soft Tissue Sarcoma

Coding & Billing References

  • •
    American Cancer Society - Soft Tissue Sarcoma

Frequently Asked Questions

What is the importance of tumor grading in C49.4?

Tumor grading is crucial as it helps determine the aggressiveness of the cancer and guides treatment decisions. Higher-grade tumors typically require more aggressive treatment and have a poorer prognosis.