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v1.0.0
ICD-10 Guide
ICD-10 CodesD13.99

D13.99

Billable

Benign neoplasm of ill-defined sites within the digestive system

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

Code Description

ICD-10 D13.99 is a billable code used to indicate a diagnosis of benign neoplasm of ill-defined sites within the digestive system.

Key Diagnostic Point:

D13.99 refers to benign neoplasms located in unspecified or ill-defined sites within the digestive system. These neoplasms can arise from various tissues within the digestive tract, including the esophagus, stomach, intestines, liver, and pancreas. While benign, these tumors can lead to symptoms such as obstruction, bleeding, or discomfort, necessitating careful monitoring and management. Surveillance is crucial as some benign neoplasms may have the potential for malignant transformation, particularly if they exhibit atypical features or if there is a family history of gastrointestinal cancers. Regular imaging and endoscopic evaluations may be recommended to assess the size and characteristics of the neoplasm. The management approach often involves a multidisciplinary team, including gastroenterologists and surgeons, to determine the best course of action, which may include surveillance, surgical intervention, or symptomatic treatment. Accurate coding is essential for appropriate reimbursement and to ensure that patients receive the necessary follow-up care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of neoplasm location
  • Need for precise differentiation from malignant neoplasms
  • Potential for overlapping symptoms with other gastrointestinal conditions
  • Requirement for detailed patient history and follow-up

Audit Risk Factors

  • Inadequate documentation of the neoplasm's characteristics
  • Failure to document surveillance or follow-up plans
  • Misclassification of benign neoplasms as malignant
  • Lack of clarity regarding the site of the neoplasm

Specialty Focus

Medical Specialties

Gastroenterology

Documentation Requirements

Detailed descriptions of the neoplasm's location, size, and characteristics, along with any imaging or biopsy results.

Common Clinical Scenarios

Patients presenting with abdominal pain, gastrointestinal bleeding, or incidental findings on imaging.

Billing Considerations

Ensure that all relevant imaging studies and follow-up plans are documented to support the diagnosis.

Surgery

Documentation Requirements

Operative reports detailing the surgical approach, findings, and any histopathological results.

Common Clinical Scenarios

Surgical intervention for symptomatic benign neoplasms or those with potential for malignancy.

Billing Considerations

Accurate coding of the surgical procedure in conjunction with the diagnosis is essential for reimbursement.

Coding Guidelines

Inclusion Criteria

Use D13.99 When
  • According to ICD
  • 10 coding guidelines, D13
  • 99 should be used when the specific site of the benign neoplasm within the digestive system is not clearly defined
  • Coders must ensure that the documentation supports the diagnosis and that the neoplasm is confirmed as benign through appropriate diagnostic procedures

Exclusion Criteria

Do NOT use D13.99 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

45378CPT Code

Colonoscopy, flexible, diagnostic

Clinical Scenario

Used for surveillance of benign polyps in the colon.

Documentation Requirements

Document findings, size, and number of polyps, and any biopsies taken.

Specialty Considerations

Gastroenterologists should ensure that all findings are clearly 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 benign neoplasms, improving the accuracy of data collection and reimbursement processes. D13.99 provides a distinct code for ill-defined sites, which was less clearly defined in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of benign neoplasms, improving the accuracy of data collection and reimbursement processes. D13.99 provides a distinct code for ill-defined sites, which was less clearly defined in ICD-9.

Reimbursement & Billing Impact

reimbursement processes. D13.99 provides a distinct code for ill-defined sites, which was less clearly defined in ICD-9.

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 D13.99 accurately?

Accurate coding of D13.99 is crucial for ensuring appropriate reimbursement, facilitating proper patient management, and maintaining accurate health records. It also aids in the identification of trends in benign neoplasms within the digestive system.