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v1.0.0
ICD-10 Guide
ICD-10 CodesR97

R97

Abnormal tumor markers

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R97 is a billable code used to indicate a diagnosis of abnormal tumor markers.

Key Diagnostic Point:

Abnormal tumor markers refer to elevated or altered levels of specific substances in the blood that may indicate the presence of cancer or other diseases. These markers are typically proteins produced by cancer cells or by the body in response to cancer. Common tumor markers include prostate-specific antigen (PSA), carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), and cancer antigen 125 (CA-125). The presence of abnormal levels of these markers can aid in the diagnosis, monitoring, and management of various malignancies. However, it is important to note that elevated tumor markers are not definitive for cancer and can be influenced by other conditions, such as benign tumors, infections, or inflammatory diseases. Therefore, abnormal tumor marker results should be interpreted in conjunction with clinical findings, imaging studies, and histopathological evaluations to establish a comprehensive diagnosis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in tumor marker specificity and sensitivity
  • Need for correlation with clinical findings and imaging
  • Potential for false positives/negatives due to non-cancerous conditions
  • Documentation of the clinical context in which the marker was tested

Audit Risk Factors

  • Inadequate documentation linking abnormal results to specific clinical conditions
  • Failure to specify the type of tumor marker tested
  • Misinterpretation of tumor marker results leading to incorrect coding
  • Lack of follow-up documentation for abnormal findings

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Clear documentation of the clinical rationale for testing tumor markers, including patient history and presenting symptoms.

Common Clinical Scenarios

Routine screening for cancer in high-risk patients, monitoring treatment response in known malignancies.

Billing Considerations

Ensure that the abnormal results are linked to a specific diagnosis or condition to avoid coding errors.

Emergency Medicine

Documentation Requirements

Immediate documentation of abnormal lab results and their clinical implications, including any acute symptoms.

Common Clinical Scenarios

Patients presenting with acute symptoms suggestive of malignancy or complications from known cancers.

Billing Considerations

Rapid assessment and documentation are crucial; ensure that abnormal findings are communicated effectively.

Coding Guidelines

Inclusion Criteria

Use R97 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used in conjunction with appropriate clinical documentation that supports the diagnosis of cancer or related conditions

Exclusion Criteria

Do NOT use R97 When
No specific exclusions found.

Related Codes

Child Codes

6 codes
R97.0
Elevated carcinoembryonic antigen [CEA]
R97.1
Elevated cancer antigen 125 [CA 125]
R97.2
Elevated prostate specific antigen [PSA]
R97.20
Elevated prostate specific antigen [PSA]
R97.21
Rising PSA following treatment for malignant neoplasm of prostate
R97.8
Other abnormal tumor markers

Related CPT Codes

84153CPT Code

Prostate-specific antigen (PSA) test

Clinical Scenario

Used for monitoring prostate cancer patients.

Documentation Requirements

Document the reason for the PSA test and any relevant clinical history.

Specialty Considerations

Urology practices should ensure thorough documentation of patient history and follow-up plans.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of abnormal tumor markers, improving the ability to capture the nuances of patient conditions and treatment needs.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of abnormal tumor markers, improving the ability to capture the nuances of patient conditions and treatment needs.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of abnormal tumor markers, improving the ability to capture the nuances of patient conditions and treatment needs.

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 are tumor markers?

Tumor markers are substances found in the blood, urine, or tissues that can be elevated in the presence of cancer. They are used to help diagnose, monitor treatment, and assess prognosis.

Can abnormal tumor markers indicate conditions other than cancer?

Yes, elevated tumor markers can also be associated with benign conditions, infections, or inflammatory diseases, which is why they must be interpreted in the context of the patient's overall clinical picture.