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ICD-10 Guide
ICD-10 CodesD42.9

D42.9

Billable

Neoplasm of uncertain behavior of meninges, unspecified

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

Code Description

ICD-10 D42.9 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of meninges, unspecified.

Key Diagnostic Point:

D42.9 refers to a neoplasm of uncertain behavior located in the meninges, which are the protective membranes covering the brain and spinal cord. These neoplasms can be benign or malignant, but their uncertain behavior indicates that their potential for progression or malignancy is not clearly defined. Clinically, these tumors may present with symptoms such as headaches, seizures, or neurological deficits, depending on their size and location. Diagnosis typically involves imaging studies like MRI or CT scans, and histopathological examination may be necessary to determine the exact nature of the tumor. Surveillance is crucial, as some neoplasms may remain stable while others could progress to malignancy. Regular follow-ups and imaging are recommended to monitor any changes in size or behavior. The management of these neoplasms may vary from observation to surgical intervention, depending on the clinical scenario and the patient's overall health status.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Uncertainty in behavior classification
  • Need for comprehensive documentation of symptoms
  • Variability in treatment approaches
  • 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 notes indicating surveillance
  • Misclassification with malignant neoplasms

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with headaches, seizures, or neurological deficits.

Billing Considerations

Ensure clear documentation of symptoms and follow-up plans to support the diagnosis.

Neurosurgery

Documentation Requirements

Surgical reports, pathology results, and post-operative follow-up notes.

Common Clinical Scenarios

Surgical intervention for symptomatic neoplasms or those showing signs of progression.

Billing Considerations

Document the rationale for surgical intervention and any histological findings.

Coding Guidelines

Inclusion Criteria

Use D42.9 When
  • According to ICD
  • 10 coding guidelines, D42
  • 9 should be used when the neoplasm's behavior is uncertain and cannot be classified as benign or malignant
  • It is essential to document the clinical findings and any imaging or pathology results that support the diagnosis

Exclusion Criteria

Do NOT use D42.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

61510CPT Code

Craniotomy, excision of brain tumor

Clinical Scenario

Used when surgical intervention is performed for a meningeal neoplasm.

Documentation Requirements

Surgical reports detailing the procedure and findings.

Specialty Considerations

Neurosurgeons must document the rationale for surgery and any histological 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. D42.9 provides a clear classification for neoplasms that do not fit neatly into benign or malignant categories, improving the accuracy of patient records and treatment plans.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior. D42.9 provides a clear classification for neoplasms that do not fit neatly into benign or malignant categories, improving the accuracy of patient records and treatment plans.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior. D42.9 provides a clear classification for neoplasms that do not fit neatly into benign or malignant categories, improving the accuracy of patient records and treatment plans.

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 D42.9?

Uncertain behavior indicates that the neoplasm may not be clearly classified as benign or malignant, necessitating careful monitoring and potential further evaluation.