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ICD-10 Guide
ICD-10 CodesChapter 2: NeoplasmsD40

D40

Billable

Neoplasm of uncertain behavior of male genital organs

Chapter 2:Neoplasms

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

Code Description

ICD-10 D40 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of male genital organs.

Key Diagnostic Point:

Neoplasms of uncertain behavior of the male genital organs, classified under ICD-10 code D40, refer to abnormal growths that do not exhibit definitive characteristics of malignancy or benignity. These neoplasms can arise in various structures of the male genital system, including the prostate, testicles, and penis. The term 'uncertain behavior' indicates that the neoplasm may have the potential to progress to malignancy, but it is not currently classified as cancerous. Surveillance is critical for these conditions, as they may require regular monitoring through imaging or biopsies to assess any changes in size, shape, or cellular characteristics. The clinical management of these neoplasms often involves a multidisciplinary approach, including urologists, oncologists, and pathologists, to determine the best course of action, which may range from active surveillance to surgical intervention, depending on the individual case and risk factors. Accurate coding of D40 is essential for appropriate treatment planning and insurance reimbursement, as it reflects the complexity and potential risks associated with these neoplasms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and behavior of neoplasms
  • Need for precise documentation of diagnostic findings
  • Potential for progression to malignancy requiring ongoing surveillance
  • Differentiation from benign and malignant conditions

Audit Risk Factors

  • Inadequate documentation of the neoplasm's behavior
  • Failure to document surveillance protocols
  • Misclassification of benign or malignant conditions
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed pathology reports, imaging studies, and clinical notes on surveillance.

Common Clinical Scenarios

Diagnosis of a testicular mass, prostate biopsy results indicating uncertain behavior.

Billing Considerations

Ensure clear documentation of the neoplasm's characteristics and any follow-up plans.

Oncology

Documentation Requirements

Comprehensive treatment plans, multidisciplinary notes, and follow-up assessments.

Common Clinical Scenarios

Management of patients with uncertain behavior neoplasms requiring potential intervention.

Billing Considerations

Document the rationale for surveillance versus intervention clearly.

Coding Guidelines

Inclusion Criteria

Use D40 When
  • According to ICD
  • 10 guidelines, D40 should be used when the neoplasm's behavior is uncertain and does not fit into benign or malignant categories
  • Documentation must support the diagnosis and indicate the need for surveillance or treatment

Exclusion Criteria

Do NOT use D40 When
No specific exclusions found.

Related CPT Codes

55700CPT Code

Biopsy of prostate

Clinical Scenario

Used when a biopsy is performed to assess a neoplasm of uncertain behavior.

Documentation Requirements

Pathology report and clinical notes indicating the need for biopsy.

Specialty Considerations

Urologists must document the rationale for biopsy clearly.

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, which aids in better tracking and management of these conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior, which aids in better tracking and management of these conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior, which aids in better tracking and management of these conditions.

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 D40?

Uncertain behavior indicates that the neoplasm does not clearly fall into benign or malignant categories, necessitating careful monitoring and potential intervention.