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ICD-10 Guide
ICD-10 CodesChapter 2: NeoplasmsD16

D16

Billable

Benign neoplasm of bone and articular cartilage

Chapter 2:Neoplasms

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

Code Description

ICD-10 D16 is a billable code used to indicate a diagnosis of benign neoplasm of bone and articular cartilage.

Key Diagnostic Point:

Benign neoplasms of bone and articular cartilage are non-cancerous growths that arise from the bone or cartilage tissue. These tumors can vary in size and may be asymptomatic or cause localized pain, swelling, or functional impairment depending on their location and size. Common types of benign bone tumors include osteochondromas, enchondromas, and osteomas. While these tumors are generally not life-threatening, they can lead to complications such as fractures or joint issues if they grow large enough to affect surrounding structures. Surveillance is often recommended to monitor for any changes in size or symptoms, as some benign tumors can exhibit growth patterns that warrant further investigation. Although the malignant potential of benign bone tumors is low, certain types, such as osteochondromas, have a rare risk of malignant transformation, particularly in patients with hereditary syndromes like multiple hereditary exostoses (MHE). Therefore, regular follow-up and imaging studies may be necessary to ensure that these tumors remain benign over time.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of benign neoplasm types requiring specific documentation
  • Potential for misclassification as malignant if not properly documented
  • Need for precise localization and description of the tumor
  • Variability in clinical presentation and symptoms

Audit Risk Factors

  • Inadequate documentation of tumor type and location
  • Failure to note surveillance or follow-up plans
  • Misdiagnosis of benign tumors as malignant
  • Lack of imaging studies to support diagnosis

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with pain or swelling in the bone, incidental findings on imaging, or post-surgical follow-up.

Billing Considerations

Ensure that the type of benign neoplasm is clearly documented, along with any associated symptoms or complications.

Radiology

Documentation Requirements

Clear imaging interpretations and descriptions of findings related to the neoplasm.

Common Clinical Scenarios

Imaging studies performed for evaluation of bone lesions, including X-rays, CT scans, or MRIs.

Billing Considerations

Radiologists should provide detailed descriptions of the size, location, and characteristics of the neoplasm.

Coding Guidelines

Inclusion Criteria

Use D16 When
  • According to ICD
  • CM guidelines, D16 codes are to be used for benign neoplasms specifically located in bone and articular cartilage
  • Documentation must specify the type and location of the neoplasm

Exclusion Criteria

Do NOT use D16 When
  • Exclusion criteria include malignant neoplasms and conditions not classified under benign tumors

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used when a patient with a benign bone tumor presents with joint effusion.

Documentation Requirements

Document the reason for the procedure, including the presence of a benign neoplasm.

Specialty Considerations

Orthopedic specialists should ensure that the diagnosis supports the need for the procedure.

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. The granularity of D16 codes facilitates better tracking of these conditions and their management.

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. The granularity of D16 codes facilitates better tracking of these conditions and their management.

Reimbursement & Billing Impact

reimbursement processes. The granularity of D16 codes facilitates better tracking of these conditions and their management.

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.