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v1.0.0
ICD-10 Guide
ICD-10 CodesC57.4

C57.4

Billable

Malignant neoplasm of uterine adnexa, unspecified

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

Code Description

ICD-10 C57.4 is a billable code used to indicate a diagnosis of malignant neoplasm of uterine adnexa, unspecified.

Key Diagnostic Point:

C57.4 refers to malignant neoplasms located in the uterine adnexa, which includes the ovaries, fallopian tubes, and surrounding connective tissues. These tumors can arise from various cell types and may present with a range of symptoms, including abdominal pain, abnormal bleeding, and changes in menstrual cycles. Diagnosis typically involves imaging studies such as ultrasound or CT scans, and may be confirmed through biopsy. The staging of these malignancies is crucial for determining treatment options and prognosis, often utilizing the FIGO (International Federation of Gynecology and Obstetrics) staging system. CA-125, a tumor marker, is frequently used in the monitoring and management of ovarian cancer, although it is not specific to malignancy and can be elevated in benign conditions. Treatment approaches may include surgical intervention, chemotherapy, and radiation therapy, depending on the stage and type of cancer. Accurate coding is essential for appropriate reimbursement and tracking of cancer incidence and outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of tumor type and location
  • Need for precise staging information
  • Differentiation from benign conditions
  • Potential for multiple concurrent gynecologic diagnoses

Audit Risk Factors

  • Inadequate documentation of tumor characteristics
  • Failure to document staging information
  • Misclassification of benign versus malignant neoplasms
  • Lack of follow-up documentation post-treatment

Specialty Focus

Medical Specialties

Gynecologic Oncology

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with pelvic masses, abnormal CA-125 levels, or abnormal imaging findings.

Billing Considerations

Ensure accurate staging and documentation of any concurrent conditions to avoid coding errors.

Radiology

Documentation Requirements

Clear imaging reports indicating findings related to the adnexa and any recommendations for further evaluation.

Common Clinical Scenarios

Imaging studies performed for suspected adnexal masses or follow-up of known malignancies.

Billing Considerations

Radiologists should provide detailed descriptions of findings to support accurate coding.

Coding Guidelines

Inclusion Criteria

Use C57.4 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the neoplasm is confirmed as malignant and the specific site is not documented
  • Include staging information when available

Exclusion Criteria

Do NOT use C57.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

58150CPT Code

Total abdominal hysterectomy with bilateral salpingo-oophorectomy

Clinical Scenario

Used when surgical intervention is performed for malignant neoplasm of the uterine adnexa.

Documentation Requirements

Operative reports detailing the procedure and findings.

Specialty Considerations

Gynecologic oncologists should ensure all findings are documented to support coding.

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 data accuracy and enhancing the ability to track treatment outcomes and resource utilization.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of gynecologic malignancies, improving data accuracy and enhancing the ability to track treatment outcomes and resource utilization.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of gynecologic malignancies, improving data accuracy and enhancing the ability to track treatment outcomes and resource utilization.

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 significance of CA-125 in coding C57.4?

CA-125 is a tumor marker often used in the diagnosis and monitoring of ovarian cancer. While it is not specific to malignancy, elevated levels can support the diagnosis of malignant neoplasms of the uterine adnexa when documented appropriately.