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v1.0.0
ICD-10 Guide
ICD-10 CodesD16.0

D16.0

Billable

Benign neoplasm of scapula and long bones of upper limb

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

Code Description

ICD-10 D16.0 is a billable code used to indicate a diagnosis of benign neoplasm of scapula and long bones of upper limb.

Key Diagnostic Point:

Benign neoplasms of the scapula and long bones of the upper limb are non-cancerous growths that can arise from various tissues, including bone, cartilage, and fibrous tissue. These neoplasms may present as asymptomatic masses or cause localized pain, swelling, or functional impairment depending on their size and location. Common types of benign neoplasms in this category include osteochondromas, enchondromas, and fibromas. Diagnosis typically involves imaging studies such as X-rays, CT scans, or MRIs, which help differentiate these benign lesions from malignant tumors. While benign, these neoplasms require monitoring due to the potential for complications, such as fracture or, in rare cases, transformation into malignant forms. Regular follow-up and imaging may be necessary to ensure stability and to assess any changes in size or characteristics. Treatment options may include observation, surgical excision, or curettage, depending on the symptoms and the specific type of neoplasm.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of benign neoplasm types that can be coded under this category
  • Need for precise documentation to differentiate from malignant neoplasms
  • Potential for misclassification if imaging results are not clearly documented
  • Variability in clinical presentation and management strategies

Audit Risk Factors

  • Inadequate documentation of imaging studies
  • Failure to document the size and characteristics of the neoplasm
  • Lack of follow-up notes indicating surveillance or treatment
  • Misclassification of benign neoplasms as malignant

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed imaging reports, surgical notes, and follow-up evaluations.

Common Clinical Scenarios

Patients presenting with shoulder pain or swelling, incidental findings on imaging.

Billing Considerations

Ensure clear documentation of the neoplasm type and any surgical interventions performed.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing the characteristics of the neoplasm.

Common Clinical Scenarios

Imaging studies performed for pain or mass evaluation in the upper limb.

Billing Considerations

Accurate descriptions of imaging findings are crucial for proper coding.

Coding Guidelines

Inclusion Criteria

Use D16.0 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the neoplasm's characteristics and any associated symptoms
  • Include relevant imaging findings and treatment plans

Exclusion Criteria

Do NOT use D16.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20680CPT Code

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

Clinical Scenario

Used when a patient with a benign neoplasm presents with joint effusion.

Documentation Requirements

Document the reason for the procedure and findings.

Specialty Considerations

Orthopedic specialists should ensure clear linkage between the diagnosis and 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. This specificity helps in better tracking of treatment outcomes and resource allocation.

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. This specificity helps in better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

reimbursement processes. This specificity helps in better tracking of treatment outcomes 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 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.