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ICD-10 Guide
ICD-10 CodesD48.11

D48.11

Billable

Desmoid tumor

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

Code Description

ICD-10 D48.11 is a billable code used to indicate a diagnosis of desmoid tumor.

Key Diagnostic Point:

Desmoid tumors, also known as aggressive fibromatosis, are benign neoplasms that arise from the connective tissue, particularly the fascia and aponeurosis. These tumors are characterized by their infiltrative growth pattern and can occur in various anatomical locations, including the abdominal wall, extremities, and trunk. Although classified as benign, desmoid tumors exhibit a tendency for local recurrence and can cause significant morbidity due to their size and location. The etiology of desmoid tumors is not fully understood, but they are often associated with genetic conditions such as familial adenomatous polyposis (FAP). Clinically, patients may present with a palpable mass, pain, or functional impairment depending on the tumor's location. Imaging studies, including MRI and CT scans, are essential for diagnosis and assessing the extent of the tumor. Treatment options vary and may include surgical excision, observation, or pharmacological interventions such as nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal therapies. Due to their uncertain behavior, ongoing surveillance is crucial to monitor for recurrence or progression, making accurate coding and documentation essential in managing these patients effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and location of tumors
  • Need for precise documentation of tumor behavior and treatment
  • Potential for recurrence requiring ongoing surveillance
  • Association with genetic syndromes complicating coding

Audit Risk Factors

  • Inadequate documentation of tumor characteristics
  • Failure to note recurrence or progression in follow-up visits
  • Misclassification of tumor behavior
  • Lack of genetic history documentation when relevant

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans must be documented.

Common Clinical Scenarios

Patients presenting with a palpable mass, pain, or functional impairment due to desmoid tumors.

Billing Considerations

Ensure accurate documentation of tumor size, location, and any surgical interventions performed.

Surgery

Documentation Requirements

Operative reports detailing excision margins and any complications.

Common Clinical Scenarios

Surgical intervention for desmoid tumors, particularly in cases of recurrence.

Billing Considerations

Document the rationale for surgical intervention versus observation.

Coding Guidelines

Inclusion Criteria

Use D48.11 When
  • According to ICD
  • 10 guidelines, D48
  • 11 should be used for desmoid tumors of uncertain behavior
  • Coders must ensure that the diagnosis is confirmed through appropriate imaging and pathology reports

Exclusion Criteria

Do NOT use D48.11 When
  • Exclusion criteria include malignant neoplasms and benign tumors with clear behavior

Related ICD-10 Codes

Related CPT Codes

19120CPT Code

Excision, tumor, soft tissue of neck or thorax

Clinical Scenario

Used when excising a desmoid tumor located in the thoracic region.

Documentation Requirements

Operative report detailing the excision and margins.

Specialty Considerations

Ensure the surgical approach is documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of desmoid tumors, improving the accuracy of data collection and treatment planning. This specificity aids in better understanding the epidemiology and management of these tumors.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of desmoid tumors, improving the accuracy of data collection and treatment planning. This specificity aids in better understanding the epidemiology and management of these tumors.

Reimbursement & Billing Impact

reimbursement and to avoid denials.

Resources

Clinical References

  • •
    National Comprehensive Cancer Network (NCCN) Guidelines

Coding & Billing References

  • •
    National Comprehensive Cancer Network (NCCN) Guidelines

Frequently Asked Questions

What is the prognosis for patients with desmoid tumors?

Desmoid tumors are benign but can be locally aggressive, leading to recurrence. Prognosis varies based on tumor location and treatment response.