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ICD-10 Guide
ICD-10 CodesC67.4

C67.4

Billable

Malignant neoplasm of posterior wall of bladder

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

Code Description

ICD-10 C67.4 is a billable code used to indicate a diagnosis of malignant neoplasm of posterior wall of bladder.

Key Diagnostic Point:

C67.4 refers to a malignant neoplasm located specifically on the posterior wall of the bladder. This type of cancer arises from the transitional epithelium lining the bladder and can present with various symptoms, including hematuria (blood in urine), dysuria (painful urination), and increased urinary frequency. The staging of bladder cancer is crucial for determining the appropriate treatment and prognosis. Staging typically follows the TNM system, which assesses tumor size (T), lymph node involvement (N), and distant metastasis (M). Surgical management may involve transurethral resection of the bladder tumor (TURBT) for localized disease, or radical cystectomy for more advanced cases. Adjuvant therapies, including chemotherapy and immunotherapy, may also be indicated based on the tumor's characteristics and stage. Accurate coding for C67.4 requires thorough documentation of the tumor's location, size, and any associated treatments, as well as a clear understanding of the patient's overall health status and treatment plan.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Specificity of tumor location (posterior wall)
  • Need for accurate staging information
  • Potential for multiple treatment modalities
  • Variability in clinical presentation

Audit Risk Factors

  • Inadequate documentation of tumor location
  • Failure to document staging details
  • Misclassification of tumor type or grade
  • Lack of clarity in treatment plans

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed pathology reports, imaging studies, and surgical notes are essential for accurate coding.

Common Clinical Scenarios

Diagnosis and management of bladder tumors, staging evaluations, and surgical interventions.

Billing Considerations

Urologists must ensure that all findings related to the tumor's location and characteristics are clearly documented.

Oncology

Documentation Requirements

Comprehensive treatment plans, including chemotherapy regimens and follow-up care.

Common Clinical Scenarios

Management of advanced bladder cancer, including systemic therapies and palliative care.

Billing Considerations

Oncologists should document the rationale for treatment choices and any patient responses to therapy.

Coding Guidelines

Inclusion Criteria

Use C67.4 When
  • According to official coding guidelines, C67
  • 4 should be used when the malignant neoplasm is confirmed by pathology and specifically located on the posterior wall of the bladder

Exclusion Criteria

Do NOT use C67.4 When
  • Exclusion criteria include benign tumors or neoplasms located in other parts of the bladder

Related ICD-10 Codes

Related CPT Codes

52260CPT Code

Cystourethroscopy with biopsy

Clinical Scenario

Used for diagnosis and staging of bladder tumors.

Documentation Requirements

Pathology report confirming malignancy and details of the procedure.

Specialty Considerations

Urologists must document findings and any interventions performed during the procedure.

51570CPT Code

Radical cystectomy

Clinical Scenario

Indicated for invasive bladder cancer.

Documentation Requirements

Operative report detailing the extent of the surgery and any complications.

Specialty Considerations

Oncologists should document the patient's preoperative status and postoperative care.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding bladder cancers, including the ability to specify the tumor's location, which is crucial for treatment and prognosis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding bladder cancers, including the ability to specify the tumor's location, which is crucial for treatment and prognosis.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding bladder cancers, including the ability to specify the tumor's location, which is crucial for treatment and prognosis.

Resources

Clinical References

  • •
    American Urological Association Guidelines
  • •
    National Comprehensive Cancer Network Guidelines

Coding & Billing References

  • •
    American Urological Association Guidelines
  • •
    National Comprehensive Cancer Network Guidelines

Frequently Asked Questions

What is the significance of staging in bladder cancer?

Staging is crucial as it determines the extent of the disease, guides treatment options, and helps predict prognosis. Accurate staging impacts the choice between surgical intervention, chemotherapy, or other therapies.

How can I ensure accurate coding for C67.4?

Accurate coding requires detailed documentation of the tumor's location, staging information, and treatment plans. Always refer to pathology reports and ensure that all clinical findings are clearly recorded.