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ICD-10 Guide
ICD-10 CodesD40.9

D40.9

Billable

Neoplasm of uncertain behavior of male genital organ, unspecified

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

Code Description

ICD-10 D40.9 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of male genital organ, unspecified.

Key Diagnostic Point:

D40.9 refers to neoplasms of uncertain behavior affecting the male genital organs, where the specific nature of the neoplasm is not clearly defined. These neoplasms may present as benign or malignant, but their behavior is indeterminate, necessitating careful monitoring and evaluation. Common examples include atypical lesions or tumors that do not fit neatly into benign or malignant categories. The uncertainty surrounding these neoplasms often leads to a recommendation for surveillance, which may include regular imaging studies or biopsies to assess any changes in size or characteristics. The potential for progression to malignancy is a significant concern, and healthcare providers must weigh the risks and benefits of intervention versus observation. Accurate coding is crucial for appropriate management and treatment planning, as well as for ensuring proper reimbursement and resource allocation in healthcare settings.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Uncertainty in behavior classification (benign vs malignant)
  • Need for thorough documentation of clinical findings
  • Variability in treatment approaches based on individual cases
  • Potential for progression requiring ongoing surveillance

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the location of the neoplasm
  • Lack of follow-up documentation for surveillance
  • Misclassification of neoplasm behavior

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed clinical notes including imaging results, biopsy reports, and follow-up plans.

Common Clinical Scenarios

Patients presenting with atypical testicular masses or penile lesions.

Billing Considerations

Urologists must document the rationale for surveillance versus intervention clearly.

Oncology

Documentation Requirements

Comprehensive treatment plans, including any chemotherapy or radiation therapy considerations.

Common Clinical Scenarios

Management of patients with uncertain neoplasms requiring oncological evaluation.

Billing Considerations

Oncologists should ensure that the potential for malignancy is clearly communicated in documentation.

Coding Guidelines

Inclusion Criteria

Use D40.9 When
  • According to ICD
  • 10 guidelines, D40
  • 9 should be used when the neoplasm's behavior is uncertain and cannot be classified as benign or malignant
  • Coders should ensure that the diagnosis is supported by clinical documentation and that the neoplasm's location is specified

Exclusion Criteria

Do NOT use D40.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

55700CPT Code

Biopsy of testis

Clinical Scenario

Used when a biopsy is performed to evaluate an indeterminate testicular mass.

Documentation Requirements

Pathology report and clinical notes detailing the indication for biopsy.

Specialty Considerations

Urologists should document the rationale for the 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. 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

reimbursement and compliance.

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 'neoplasm of uncertain behavior' mean?

It refers to a growth that cannot be definitively classified as benign or malignant, requiring careful monitoring.

When should D40.9 be used?

D40.9 should be used when a neoplasm in the male genital organ is identified as having uncertain behavior, and no specific diagnosis can be made.