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ICD-10 Guide
ICD-10 CodesD48.4

D48.4

Billable

Neoplasm of uncertain behavior of peritoneum

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

Code Description

ICD-10 D48.4 is a billable code used to indicate a diagnosis of neoplasm of uncertain behavior of peritoneum.

Key Diagnostic Point:

Neoplasms of uncertain behavior of the peritoneum are tumors that do not exhibit definitive characteristics of malignancy or benignity. These neoplasms can arise from various cell types within the peritoneal cavity, including mesothelial cells, connective tissue, and other structures. The behavior of these neoplasms is classified as uncertain due to the lack of clear histological features that would categorize them as benign or malignant. Clinically, patients may present with abdominal pain, distension, or other nonspecific symptoms. Surveillance is crucial as these neoplasms have the potential for progression to malignancy, necessitating regular monitoring through imaging studies and possibly biopsies. The management of these neoplasms often involves a multidisciplinary approach, including surgical evaluation and oncological consultation, to determine the best course of action based on the tumor's behavior and patient symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in histological interpretation
  • Need for ongoing surveillance and monitoring
  • Potential for progression to malignancy
  • Documentation of clinical findings and imaging results

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document surveillance plans
  • Misinterpretation of histological reports
  • Inconsistent coding of related procedures

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Patients presenting with abdominal masses or ascites requiring evaluation.

Billing Considerations

Ensure clear documentation of tumor behavior and follow-up plans.

Surgery

Documentation Requirements

Operative reports, pre-operative assessments, and post-operative follow-up notes.

Common Clinical Scenarios

Surgical intervention for suspected neoplasms of the peritoneum.

Billing Considerations

Document the rationale for surgical intervention and findings during surgery.

Coding Guidelines

Inclusion Criteria

Use D48.4 When
  • According to ICD
  • 10 coding guidelines, D48
  • 4 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 context and any relevant imaging or pathology results

Exclusion Criteria

Do NOT use D48.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

49000CPT Code

Exploratory laparotomy

Clinical Scenario

Used when a patient with a peritoneal neoplasm undergoes surgical exploration.

Documentation Requirements

Operative report detailing findings and any biopsies taken.

Specialty Considerations

Ensure the surgical rationale is clearly documented.

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 enhances the ability to track and manage these conditions effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior, which enhances the ability to track and manage these conditions effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of neoplasms, including those of uncertain behavior, which enhances the ability to track and manage these conditions effectively.

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 'neoplasm of uncertain behavior' mean?

It refers to tumors that cannot be definitively classified as benign or malignant based on current histological and clinical findings.