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ICD-10 Guide
ICD-10 CodesC79.5

C79.5

Billable

Secondary malignant neoplasm of bone and bone marrow

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

Code Description

ICD-10 C79.5 is a billable code used to indicate a diagnosis of secondary malignant neoplasm of bone and bone marrow.

Key Diagnostic Point:

C79.5 refers to secondary malignant neoplasms that have metastasized to the bone and bone marrow from a primary cancer site. This condition is characterized by the presence of malignant cells in the bone tissue, which can lead to various complications such as pain, fractures, and hematological abnormalities. The most common primary cancers that metastasize to bone include breast, prostate, lung, and kidney cancers. Patients may present with localized bone pain, swelling, or systemic symptoms such as fatigue and weight loss. Diagnosis typically involves imaging studies like X-rays, CT scans, or MRIs, along with biopsy when necessary. Staging of metastatic bone disease is crucial for treatment planning and may involve the use of the TNM classification system. Palliative care is often a significant component of management, focusing on pain relief and improving the quality of life, especially in advanced stages of the disease. Understanding the nuances of coding for metastatic disease, including the identification of unknown primary sites, is essential for accurate documentation and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Determining the primary site of cancer when unknown.
  • Differentiating between primary bone tumors and metastatic lesions.
  • Staging considerations that may affect treatment and coding.
  • Documentation of palliative care measures.

Audit Risk Factors

  • Inadequate documentation of the primary cancer site.
  • Failure to document staging information.
  • Misclassification of primary versus secondary tumors.
  • Lack of clarity in palliative care documentation.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed history of the primary cancer, imaging results, and treatment plans.

Common Clinical Scenarios

Patients with known primary cancers presenting with bone pain or fractures.

Billing Considerations

Accurate staging and documentation of metastasis are crucial for treatment planning.

Palliative Care

Documentation Requirements

Comprehensive assessment of symptoms, treatment goals, and patient preferences.

Common Clinical Scenarios

Patients with advanced cancer requiring symptom management.

Billing Considerations

Focus on quality of life and pain management documentation.

Coding Guidelines

Inclusion Criteria

Use C79.5 When
  • According to ICD
  • 10 guidelines, C79
  • 5 should be used when there is clear documentation of metastatic disease to the bone or bone marrow
  • It is important to ensure that the primary site is identified or documented as unknown if applicable

Exclusion Criteria

Do NOT use C79.5 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

77080CPT Code

Bone density measurement

Clinical Scenario

Used for assessing bone health in patients with metastatic disease.

Documentation Requirements

Document the reason for the bone density test and any relevant clinical history.

Specialty Considerations

Oncology specialists should ensure that the test is justified based on the patient's cancer history.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of metastatic diseases, improving the accuracy of data collection and reimbursement processes. C79.5 provides a clear distinction for secondary malignancies in bone, which aids in treatment planning and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of metastatic diseases, improving the accuracy of data collection and reimbursement processes. C79.5 provides a clear distinction for secondary malignancies in bone, which aids in treatment planning and resource allocation.

Reimbursement & Billing Impact

reimbursement processes. C79.5 provides a clear distinction for secondary malignancies in bone, which aids in treatment planning and resource allocation.

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 coding C79.5?

Coding C79.5 accurately reflects the presence of metastatic disease in the bone, which is crucial for treatment planning, resource allocation, and understanding the patient's prognosis.