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v1.0.0
ICD-10 Guide
ICD-10 CodesC54.0

C54.0

Billable

Malignant neoplasm of isthmus uteri

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

Code Description

ICD-10 C54.0 is a billable code used to indicate a diagnosis of malignant neoplasm of isthmus uteri.

Key Diagnostic Point:

C54.0 refers to a malignant neoplasm located at the isthmus of the uterus, which is the narrow region connecting the cervix to the body of the uterus. This type of cancer is classified under gynecologic malignancies and can present with various symptoms, including abnormal vaginal bleeding, pelvic pain, and changes in menstrual patterns. The diagnosis is typically confirmed through histopathological examination following a biopsy. Staging of the cancer is crucial for determining the extent of disease and guiding treatment options, which may include surgery, radiation therapy, and chemotherapy. The CA-125 blood test may be utilized as a tumor marker, particularly in monitoring treatment response and recurrence, although it is not specific to uterine cancers. Surgical approaches often involve hysterectomy, which may be total or radical, depending on the stage and spread of the malignancy. Accurate coding for C54.0 is essential for appropriate treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in staging and treatment options
  • Need for precise documentation of tumor location and characteristics
  • Potential for overlapping symptoms with benign conditions
  • Importance of accurate histopathological reporting

Audit Risk Factors

  • Inadequate documentation of tumor staging
  • Failure to report histopathological findings
  • Misinterpretation of CA-125 levels
  • Coding based on incomplete clinical information

Specialty Focus

Medical Specialties

Gynecologic Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and surgical notes.

Common Clinical Scenarios

Diagnosis and treatment planning for uterine cancers, including staging and follow-up care.

Billing Considerations

Ensure accurate documentation of tumor size, grade, and staging to support coding.

Radiology

Documentation Requirements

Imaging reports that detail findings related to the isthmus and surrounding structures.

Common Clinical Scenarios

Preoperative imaging for surgical planning and post-treatment surveillance.

Billing Considerations

Radiologists should clearly document any findings that may indicate malignancy.

Coding Guidelines

Inclusion Criteria

Use C54.0 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • 0 should be used when the malignancy is confirmed and specifically located at the isthmus of the uterus

Exclusion Criteria

Do NOT use C54.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

58150CPT Code

Total abdominal hysterectomy

Clinical Scenario

Performed for treatment of malignant neoplasm of isthmus uteri.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Ensure that the surgical approach and findings are clearly documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of gynecologic malignancies, improving the accuracy of data collection and reimbursement processes for conditions like C54.0.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of gynecologic malignancies, improving the accuracy of data collection and reimbursement processes for conditions like C54.0.

Reimbursement & Billing Impact

reimbursement processes for conditions like C54.0.

Resources

Clinical References

  • •
    American Cancer Society - Uterine Cancer

Coding & Billing References

  • •
    American Cancer Society - Uterine Cancer

Frequently Asked Questions

What is the significance of CA-125 in C54.0?

CA-125 is a tumor marker that can help in monitoring treatment response and recurrence in patients with malignant neoplasms of the uterus, including C54.0. However, it is not specific to uterine cancer and should be interpreted in conjunction with other clinical findings.