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ICD-10 Guide
ICD-10 CodesD43.4

D43.4

Billable

Neoplasm of uncertain behavior of spinal cord

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

Code Description

ICD-10 D43.4 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of spinal cord.

Key Diagnostic Point:

D43.4 refers to a neoplasm of uncertain behavior located in the spinal cord. These neoplasms are characterized by their ambiguous biological behavior, which means that their potential for malignancy is not clearly defined. They may exhibit features that are benign, but they can also have the potential for aggressive behavior or progression. The diagnosis typically arises from imaging studies, such as MRI, and may require histological examination to ascertain the nature of the tumor. Surveillance is crucial for these patients, as the neoplasm may change over time, necessitating regular follow-ups and imaging to monitor for any signs of progression or transformation into a malignant state. The management of these neoplasms often involves a multidisciplinary approach, including neurosurgery, oncology, and radiology, to determine the best course of action based on the tumor's behavior and the patient's overall health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Ambiguity in behavior classification
  • Need for detailed documentation of imaging and pathology results
  • Potential for progression requiring ongoing surveillance
  • Variability in treatment approaches based on tumor behavior

Audit Risk Factors

  • Inadequate documentation of tumor behavior
  • Failure to document follow-up imaging results
  • Misclassification of tumor type
  • Lack of clarity in treatment plans

Specialty Focus

Medical Specialties

Neurosurgery

Documentation Requirements

Detailed operative reports and pathology results are essential.

Common Clinical Scenarios

Surgical intervention for tumor resection or biopsy.

Billing Considerations

Ensure clear documentation of tumor characteristics and surgical findings.

Oncology

Documentation Requirements

Comprehensive treatment plans and follow-up notes.

Common Clinical Scenarios

Management of neoplasm through chemotherapy or radiation therapy.

Billing Considerations

Document the rationale for treatment decisions based on tumor behavior.

Coding Guidelines

Inclusion Criteria

Use D43.4 When
  • According to ICD
  • 10 guidelines, D43
  • 4 should be used when the neoplasm's behavior is uncertain and specifically located in the spinal cord
  • Coders must ensure that the diagnosis is supported by appropriate imaging and pathology reports

Exclusion Criteria

Do NOT use D43.4 When
  • Exclusion criteria include confirmed malignant neoplasms or benign tumors that have a clear classification

Related ICD-10 Codes

Related CPT Codes

63030CPT Code

Laminectomy, for excision of spinal cord tumor

Clinical Scenario

Used when surgical intervention is performed for a neoplasm of uncertain behavior.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Neurosurgeons must document the tumor's characteristics and any complications.

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 treatment efficacy.

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 treatment efficacy.

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 treatment efficacy.

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 D43.4?

Coding D43.4 accurately reflects the patient's diagnosis of a neoplasm of uncertain behavior, which is crucial for appropriate management and surveillance. It also impacts treatment decisions and insurance reimbursement.