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v1.0.0
ICD-10 Guide
ICD-10 CodesD12.9

D12.9

Billable

Benign neoplasm of anus and anal canal

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

Code Description

ICD-10 D12.9 is a billable code used to indicate a diagnosis of benign neoplasm of anus and anal canal.

Key Diagnostic Point:

Benign neoplasms of the anus and anal canal are non-cancerous growths that can arise from various tissues in the anal region. These neoplasms may include adenomas, fibromas, and lipomas, among others. Clinically, they can present as asymptomatic masses or may cause symptoms such as bleeding, discomfort, or obstruction depending on their size and location. Surveillance for these neoplasms is essential, particularly for adenomatous polyps, which have a potential for malignant transformation over time. Regular monitoring through colonoscopy or anoscopy is recommended, especially in patients with a history of colorectal polyps or familial syndromes. The management of benign neoplasms often involves surgical excision, particularly if they are symptomatic or if there is uncertainty regarding their nature. Accurate coding of these conditions is crucial for appropriate treatment planning and reimbursement, as well as for tracking the incidence of these neoplasms in the population.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between benign and malignant neoplasms
  • Variability in clinical presentation and symptoms
  • Need for precise documentation of size and location
  • Potential for malignant transformation requiring surveillance

Audit Risk Factors

  • Inadequate documentation of the neoplasm's characteristics
  • Failure to document surveillance recommendations
  • Misclassification of benign neoplasms as malignant
  • Lack of follow-up documentation post-treatment

Specialty Focus

Medical Specialties

Gastroenterology

Documentation Requirements

Detailed descriptions of the neoplasm, including size, location, and symptoms.

Common Clinical Scenarios

Patients presenting with rectal bleeding or anal masses.

Billing Considerations

Ensure documentation reflects the need for surveillance and any prior history of neoplasms.

Surgery

Documentation Requirements

Operative reports detailing excision and pathology results.

Common Clinical Scenarios

Surgical removal of symptomatic anal masses.

Billing Considerations

Document the rationale for surgery and any findings that may indicate malignancy.

Coding Guidelines

Inclusion Criteria

Use D12.9 When
  • According to ICD
  • 10 guidelines, D12
  • 9 is used for benign neoplasms of the anus and anal canal that are not specified further
  • It is important to document the specific type of neoplasm when possible and to follow up with appropriate surveillance protocols

Exclusion Criteria

Do NOT use D12.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

46200CPT Code

Excision of anal lesion

Clinical Scenario

Used when a benign neoplasm is excised.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Ensure the procedure is documented in the context of the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of benign neoplasms, improving data accuracy and facilitating better tracking of these conditions in the healthcare system.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of benign neoplasms, improving data accuracy and facilitating better tracking of these conditions in the healthcare system.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of benign neoplasms, improving data accuracy and facilitating better tracking of these conditions in the healthcare system.

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 difference between benign and malignant neoplasms?

Benign neoplasms are non-cancerous growths that do not invade surrounding tissues or metastasize, while malignant neoplasms are cancerous and can spread to other parts of the body.