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v1.0.0
ICD-10 Guide
ICD-10 CodesD12.6

D12.6

Billable

Benign neoplasm of colon, unspecified

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

Code Description

ICD-10 D12.6 is a billable code used to indicate a diagnosis of benign neoplasm of colon, unspecified.

Key Diagnostic Point:

A benign neoplasm of the colon refers to a non-cancerous growth that arises from the epithelial cells lining the colon. These neoplasms can vary in size and may be asymptomatic or cause symptoms such as abdominal pain, changes in bowel habits, or rectal bleeding. Common types of benign neoplasms in the colon include adenomatous polyps, hyperplastic polyps, and sessile serrated adenomas. While benign, these neoplasms can have malignant potential, particularly adenomatous polyps, which may progress to colorectal cancer if left untreated. Surveillance colonoscopy is often recommended for patients with a history of polyps to monitor for new growths or changes in existing polyps. The unspecified designation indicates that the specific type of benign neoplasm has not been documented, which may complicate management and surveillance strategies. Accurate coding is essential for appropriate patient care and resource allocation, as well as for tracking the incidence of colorectal neoplasms in the population.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Lack of specificity in the diagnosis
  • Variability in benign neoplasm types
  • Potential for malignant transformation
  • Need for ongoing surveillance and monitoring

Audit Risk Factors

  • Inadequate documentation of the neoplasm type
  • Failure to document surveillance recommendations
  • Misclassification of benign neoplasms as malignant
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Gastroenterology

Documentation Requirements

Detailed documentation of the type of neoplasm, size, location, and any symptoms.

Common Clinical Scenarios

Patients presenting with polyps found during colonoscopy, follow-up for previously diagnosed benign neoplasms.

Billing Considerations

Ensure that the type of neoplasm is specified when possible to guide surveillance and management.

Pathology

Documentation Requirements

Histopathological reports detailing the characteristics of the neoplasm.

Common Clinical Scenarios

Pathological examination of colon biopsy specimens.

Billing Considerations

Accurate reporting of findings is crucial for proper coding and subsequent management.

Coding Guidelines

Inclusion Criteria

Use D12.6 When
  • According to ICD
  • 10 coding guidelines, D12
  • 6 should be used when the specific type of benign neoplasm is not documented
  • Coders should ensure that the diagnosis is supported by clinical documentation and that any relevant history of polyps is noted

Exclusion Criteria

Do NOT use D12.6 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

45378CPT Code

Colonoscopy, flexible, diagnostic

Clinical Scenario

Used for surveillance of benign neoplasms.

Documentation Requirements

Indication for the procedure and findings must be documented.

Specialty Considerations

Gastroenterologists should ensure that the type of neoplasm is noted in the report.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more detailed coding of benign neoplasms, improving the ability to track and manage these conditions. However, the unspecified nature of D12.6 can lead to challenges in patient management and surveillance.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more detailed coding of benign neoplasms, improving the ability to track and manage these conditions. However, the unspecified nature of D12.6 can lead to challenges in patient management and surveillance.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more detailed coding of benign neoplasms, improving the ability to track and manage these conditions. However, the unspecified nature of D12.6 can lead to challenges in patient management and surveillance.

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 should I document if a patient has a benign neoplasm of the colon?

Document the type of neoplasm if known, size, location, any symptoms, and recommendations for surveillance or follow-up.

When should I use D12.6 instead of a more specific code?

Use D12.6 when the specific type of benign neoplasm is not documented or cannot be determined.