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v1.0.0
ICD-10 Guide
ICD-10 CodesChapter 2: NeoplasmsD43

D43

Billable

Neoplasm of uncertain behavior of brain and central nervous system

Chapter 2:Neoplasms

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

Code Description

ICD-10 D43 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of brain and central nervous system.

Key Diagnostic Point:

D43 refers to neoplasms of uncertain behavior that occur in the brain and central nervous system (CNS). These neoplasms are characterized by their ambiguous histological features, which do not allow for a definitive classification as benign or malignant. The behavior of these tumors can vary significantly, and they may exhibit a potential for progression or recurrence. Clinicians often rely on imaging studies, histopathological evaluations, and clinical judgment to monitor these neoplasms. Surveillance is critical, as some tumors may remain stable for extended periods, while others may demonstrate aggressive behavior over time. The management of patients with D43 neoplasms typically involves regular follow-up with imaging and neurological assessments to detect any changes in size or symptoms. Treatment options may include surgical intervention, radiation therapy, or observation, depending on the tumor's characteristics and the patient's overall health. Accurate coding of D43 is essential for appropriate patient management and resource allocation in healthcare settings.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Ambiguity in histological classification
  • Need for ongoing surveillance and monitoring
  • Variability in clinical presentation and behavior
  • Potential for progression requiring careful documentation

Audit Risk Factors

  • Inadequate documentation of tumor behavior
  • Failure to document surveillance findings
  • Misclassification of tumor type
  • Lack of follow-up notes indicating monitoring

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological assessments, imaging results, and treatment plans must be documented.

Common Clinical Scenarios

Patients presenting with headaches, seizures, or neurological deficits requiring imaging and follow-up.

Billing Considerations

Neurologists must ensure that the behavior of the neoplasm is clearly documented to support the coding.

Oncology

Documentation Requirements

Histopathological reports, treatment plans, and follow-up imaging results are essential.

Common Clinical Scenarios

Patients undergoing treatment for CNS neoplasms, including chemotherapy or radiation therapy.

Billing Considerations

Oncologists should document the rationale for treatment decisions based on tumor behavior.

Coding Guidelines

Inclusion Criteria

Use D43 When
  • According to ICD
  • 10 guidelines, D43 should be used when the neoplasm's behavior is uncertain and cannot be classified as benign or malignant
  • Coders must ensure that the documentation supports the diagnosis and reflects the ongoing monitoring of the condition

Exclusion Criteria

Do NOT use D43 When
No specific exclusions found.

Related CPT Codes

70553CPT Code

MRI brain with contrast

Clinical Scenario

Used for initial evaluation and follow-up of D43 neoplasms.

Documentation Requirements

Document indication for MRI and findings related to the neoplasm.

Specialty Considerations

Neurologists and oncologists should ensure imaging results are clearly linked to the diagnosis.

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 is the significance of coding D43?

Coding D43 accurately reflects the uncertainty of the tumor's behavior, which is crucial for appropriate management and resource allocation in patient care.