ICD-10 Coding for Colon Mass(C18.9, D12.6, K63.5)
Complete ICD-10-CM coding and documentation guide for Colon Mass. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Colon Mass
C18-C19Primary Range
Malignant neoplasms of colon and rectosigmoid junction
Primary range for coding malignant colon masses, including specific sites like ascending, transverse, and sigmoid colon.
Benign neoplasms of colon, rectum, anus, and anal canal
Used for benign colon masses, such as adenomas and polyps.
Other diseases of intestine
Includes non-neoplastic conditions like polyps without neoplastic features.
Other symptoms and signs involving the digestive system and abdomen
Used for unspecified abdominal masses when further specification is not available.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C18.9 | Malignant neoplasm of colon, unspecified | Use when malignancy is confirmed but specific site is not documented. |
|
| D12.6 | Benign neoplasm of colon, unspecified | Use when a benign tumor is confirmed but specific site is not documented. |
|
| K63.5 | Polyp of colon | Use for non-neoplastic polyps identified during colonoscopy. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for colon mass
Essential facts and insights about Colon Mass
Primary ICD-10-CM Codes for colon mass
Decision Criteria
clinical Criteria
- Biopsy confirms adenocarcinoma
documentation Criteria
- Site of tumor not specified
Applicable To
- Colon cancer not otherwise specified
Clinical Validation Requirements
- Biopsy-confirmed malignancy
- Imaging showing mass >3 cm
Code-Specific Risks
- Risk of unspecified coding if site is known but not documented.
Coding Notes
- Ensure malignancy is confirmed via biopsy before coding.
D12.6 - Benign neoplasm of colon, unspecified
Use when a benign tumor is confirmed but specific site is not documented.
Applicable To
- Colon adenoma not otherwise specified
Excludes
- Malignant neoplasms of colon (C18.9)
Clinical Validation Requirements
- Histology report confirming benign nature
Coding Notes
Ensure benign nature is confirmed via histology.
K63.5 - Polyp of colon
Use for non-neoplastic polyps identified during colonoscopy.
Applicable To
- Hyperplastic polyp
Excludes
- Neoplastic polyps (D12.6)
Clinical Validation Requirements
- Endoscopic findings of non-neoplastic polyp
Coding Notes
Ensure polyp is non-neoplastic before coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Secondary malignant neoplasm of large intestine
C78.5Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Colon Mass to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C18.9.
Impact
Clinical: Potential misdiagnosis or delayed treatment., Regulatory: Non-compliance with documentation standards., Financial: Denial of claims due to lack of specificity.
Mitigation Strategy
Always specify the site and histology in documentation., Use templates to ensure completeness.
Impact
Reimbursement: Potential overbilling if malignancy is not confirmed., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on cancer prevalence.
Mitigation Strategy
Use R19.5 until malignancy is confirmed by biopsy.
Impact
Reimbursement: Incorrect billing for benign neoplasms., Compliance: Violation of coding specificity requirements., Data Quality: Misrepresentation of polyp types in data.
Mitigation Strategy
Code D12.6 for neoplastic polyps.
Impact
Using unspecified codes without sufficient documentation.
Mitigation Strategy
Require biopsy confirmation and detailed site documentation.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Colon Mass, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Colon Mass
Use these documentation templates to ensure complete and accurate documentation for Colon Mass. These templates include all required elements for proper coding and billing.
Colonoscopy with biopsy
Specialty: GastroenterologyRequired Elements
- Findings
- Biopsy results
- Imaging studies
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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