ICD-10 Coding for Gastric Mass(C16.9, D13.1)
Complete ICD-10-CM coding and documentation guide for Gastric Mass. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gastric Mass
C16.0-C16.9Primary Range
Malignant neoplasms of the stomach
Primary range for coding malignant gastric masses.
Gastric intestinal metaplasia
Codes for gastric metaplasia, which may present as a mass.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C16.9 | Malignant neoplasm of stomach, unspecified | Use when a malignant gastric mass is confirmed but specific location is not documented. |
|
| D13.1 | Benign neoplasm of stomach | Use for benign gastric tumors confirmed by histology. |
|
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 gastric mass
Essential facts and insights about Gastric Mass
Primary ICD-10-CM Codes for gastric mass
Decision Criteria
clinical Criteria
- Confirmed malignancy via biopsy
documentation Criteria
- Location of mass not specified
Applicable To
- Gastric cancer
- Stomach cancer
Excludes
- Benign gastric tumors
- Gastric polyps
Clinical Validation Requirements
- Biopsy-proven adenocarcinoma
- Endoscopic visualization of mass
Code-Specific Risks
- Risk of unspecified location leading to audit issues.
Coding Notes
- Ensure documentation specifies malignancy to avoid misclassification.
D13.1 - Benign neoplasm of stomach
Use for benign gastric tumors confirmed by histology.
Applicable To
- GIST
- Leiomyoma
Excludes
- Malignant gastric tumors
Clinical Validation Requirements
- Histological confirmation of benign nature
- Immunohistochemistry results
Coding Notes
Ensure benign nature is clearly documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for screening for malignant neoplasms of digestive organs
Z12.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Gastric Mass to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C16.9.
Impact
Clinical: Impacts treatment decisions and prognosis., Regulatory: Non-compliance with coding guidelines., Financial: Potential for denied claims due to lack of specificity.
Mitigation Strategy
Use structured templates, Ensure biopsy results are included in documentation
Impact
Reimbursement: Incorrect DRG assignment leading to financial discrepancies., Compliance: Potential audit trigger due to incorrect site coding., Data Quality: Inaccurate clinical data affecting treatment decisions.
Mitigation Strategy
Use C16.0 if the epicenter is more than 2 cm into the stomach.
Impact
Incorrect coding of gastric vs. esophageal masses.
Mitigation Strategy
Verify epicenter location and use appropriate codes.
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 Gastric Mass, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gastric Mass
Use these documentation templates to ensure complete and accurate documentation for Gastric Mass. These templates include all required elements for proper coding and billing.
Gastric cancer diagnosis
Specialty: GastroenterologyRequired Elements
- Tumor location
- Histological type
- Size and depth of invasion
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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