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ICD-10 Guide
ICD-10 CodesD38.6

D38.6

Billable

Neoplasm of uncertain behavior of respiratory organ, unspecified

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

Code Description

ICD-10 D38.6 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of respiratory organ, unspecified.

Key Diagnostic Point:

D38.6 refers to a neoplasm of uncertain behavior located in the respiratory organs, which includes the trachea, bronchi, lungs, and pleura. Neoplasms of uncertain behavior are characterized by their indeterminate potential for malignancy, meaning they may exhibit benign or malignant characteristics but do not fit neatly into either category. This uncertainty necessitates careful monitoring and evaluation, as these neoplasms can potentially progress to malignancy over time. The diagnosis often arises from imaging studies or biopsies that reveal atypical cellular features without definitive evidence of malignancy. Clinicians may recommend regular surveillance through imaging or repeat biopsies to assess for changes in size, appearance, or symptoms. The management of these neoplasms is complex and may involve a multidisciplinary approach, including pulmonologists, oncologists, and radiologists, to determine the best course of action based on the individual patient's risk factors and clinical presentation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Uncertainty in behavior classification
  • Need for ongoing surveillance and monitoring
  • Potential for progression to malignancy
  • Variability in clinical presentation

Audit Risk Factors

  • Inadequate documentation of surveillance plans
  • Failure to document clinical rationale for monitoring
  • Misclassification of neoplasm behavior
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Pulmonology

Documentation Requirements

Detailed imaging reports, biopsy results, and clinical notes on patient history and symptoms.

Common Clinical Scenarios

Patients presenting with incidental findings on chest imaging or those with persistent respiratory symptoms.

Billing Considerations

Ensure thorough documentation of the decision-making process regarding surveillance and management strategies.

Oncology

Documentation Requirements

Comprehensive treatment plans, pathology reports, and follow-up notes detailing the patient's response to treatment.

Common Clinical Scenarios

Patients with a history of neoplasms undergoing evaluation for potential malignancy.

Billing Considerations

Document the multidisciplinary approach and any consultations with other specialties.

Coding Guidelines

Inclusion Criteria

Use D38.6 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include any relevant imaging or biopsy results that indicate the neoplasm's behavior

Exclusion Criteria

Do NOT use D38.6 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

31600CPT Code

Bronchoscopy, rigid or flexible

Clinical Scenario

Used for direct visualization and biopsy of lung lesions.

Documentation Requirements

Document indications for bronchoscopy, findings, and any biopsies performed.

Specialty Considerations

Pulmonologists should 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, improving the accuracy of patient records and facilitating better tracking of these conditions over time.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior, improving the accuracy of patient records and facilitating better tracking of these conditions over time.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior, improving the accuracy of patient records and facilitating better tracking of these conditions over time.

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 exhibits characteristics that do not clearly classify it as benign or malignant, necessitating further evaluation and monitoring.