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v1.0.0
ICD-10 Guide
ICD-10 CodesD38.5

D38.5

Billable

Neoplasm of uncertain behavior of other respiratory organs

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

Code Description

ICD-10 D38.5 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of other respiratory organs.

Key Diagnostic Point:

D38.5 refers to neoplasms of uncertain behavior that arise in the respiratory organs, excluding the lungs. These neoplasms may present as benign or malignant but lack definitive histological characteristics to classify them as either. The term 'uncertain behavior' indicates that the neoplasm may have the potential for malignant transformation, necessitating careful monitoring and follow-up. Common sites for these neoplasms include the trachea, bronchi, and pleura. Clinical management often involves imaging studies, biopsies, and possibly surgical intervention, depending on the size, location, and symptoms associated with the neoplasm. Surveillance is critical, as these neoplasms can progress, and timely intervention may be required to prevent complications. The uncertainty surrounding their behavior underscores the importance of a multidisciplinary approach in treatment planning, involving oncologists, pulmonologists, and pathologists to ensure optimal patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and histological findings
  • Need for comprehensive documentation of surveillance and follow-up
  • Potential for misclassification with other neoplasms
  • Interdisciplinary collaboration required for accurate diagnosis and treatment

Audit Risk Factors

  • Inadequate documentation of follow-up care
  • Failure to specify the site of the neoplasm
  • Misinterpretation of biopsy results
  • Lack of interdisciplinary notes in the medical record

Specialty Focus

Medical Specialties

Pulmonology

Documentation Requirements

Detailed imaging reports, biopsy results, and treatment plans must be documented.

Common Clinical Scenarios

Patients presenting with respiratory symptoms and incidental findings on imaging.

Billing Considerations

Ensure that all imaging and follow-up plans are clearly outlined to support the diagnosis.

Oncology

Documentation Requirements

Comprehensive treatment history, including chemotherapy or radiation therapy details.

Common Clinical Scenarios

Patients with a history of neoplasms requiring surveillance for potential progression.

Billing Considerations

Document any changes in behavior or symptoms that may indicate progression.

Coding Guidelines

Inclusion Criteria

Use D38.5 When
  • According to ICD
  • 10 coding guidelines, D38
  • 5 should be used when the neoplasm's behavior is uncertain and cannot be classified as benign or malignant
  • Coders must ensure that the diagnosis is supported by appropriate clinical documentation and that the site of the neoplasm is specified

Exclusion Criteria

Do NOT use D38.5 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

31625CPT Code

Bronchoscopy, rigid or flexible

Clinical Scenario

Used for biopsy of neoplasms in the respiratory tract.

Documentation Requirements

Document indication for the procedure and findings.

Specialty Considerations

Pulmonologists must ensure that the procedure is justified based on clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior. This specificity aids in better tracking of patient outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior. This specificity aids in better tracking of patient outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior. This specificity aids in better tracking of patient 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 does 'uncertain behavior' mean in the context of neoplasms?

Uncertain behavior indicates that the neoplasm cannot be definitively classified as benign or malignant based on current histological findings, necessitating careful monitoring and follow-up.