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v1.0.0
ICD-10 Guide
ICD-10 CodesD43.2

D43.2

Billable

Neoplasm of uncertain behavior of brain, unspecified

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

Code Description

ICD-10 D43.2 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of brain, unspecified.

Key Diagnostic Point:

D43.2 refers to a neoplasm of uncertain behavior located in the brain, where the specific nature of the tumor is not clearly defined as benign or malignant. These neoplasms may arise from various brain tissues and can exhibit atypical cellular characteristics that complicate diagnosis and treatment. The uncertainty surrounding these tumors necessitates careful monitoring and evaluation, as they may have the potential for progression into more aggressive forms. Clinicians often rely on imaging studies, histopathological examination, and clinical judgment to assess the behavior of these neoplasms. Surveillance strategies may include regular MRI scans and neurological assessments to detect any changes in size or symptoms. The management of patients with D43.2 may involve a multidisciplinary approach, including neurosurgery, oncology, and radiation therapy, depending on the tumor's behavior and the patient's overall health. Accurate coding of this condition is crucial for appropriate treatment planning and resource allocation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in tumor behavior and characteristics
  • Need for comprehensive documentation of clinical findings
  • Potential for progression requiring ongoing surveillance
  • Differentiation from other brain neoplasms

Audit Risk Factors

  • Inadequate documentation of tumor characteristics
  • Failure to update surveillance findings
  • Misclassification of tumor behavior
  • Lack of interdisciplinary communication in documentation

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 should ensure that all findings are clearly documented to support the diagnosis of uncertain behavior.

Oncology

Documentation Requirements

Comprehensive treatment plans, pathology reports, and follow-up care documentation are essential.

Common Clinical Scenarios

Management of patients with brain tumors requiring chemotherapy or radiation therapy.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use D43.2 When
  • According to ICD
  • 10 coding guidelines, D43
  • 2 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 that any related conditions are also coded appropriately

Exclusion Criteria

Do NOT use D43.2 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

70553CPT Code

MRI Brain with and without contrast

Clinical Scenario

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

Documentation Requirements

Indication for MRI and findings must be documented.

Specialty Considerations

Radiologists should ensure clarity in reports regarding tumor characteristics.

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

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.

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 brain neoplasms?

Uncertain behavior indicates that the tumor cannot be definitively classified as benign or malignant based on current clinical and pathological findings. This necessitates careful monitoring and potential intervention.