ICD-10 Coding for Gastrointestinal Stromal Tumor(C49.A0, C49.A1)
Complete ICD-10-CM coding and documentation guide for Gastrointestinal Stromal Tumor. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gastrointestinal Stromal Tumor
C49.A-Primary Range
Gastrointestinal stromal tumors
This range includes all site-specific codes for GISTs, which are essential for accurate diagnosis and treatment coding.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C49.A0 | Gastrointestinal stromal tumor of esophagus | Use when GIST is confirmed in the esophagus with appropriate histological and immunohistochemical findings. |
|
| C49.A1 | Gastrointestinal stromal tumor of stomach | Use for confirmed GISTs located in the stomach with appropriate histological findings. |
|
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 GIST
Essential facts and insights about Gastrointestinal Stromal Tumor
Primary ICD-10-CM Codes for gist
Decision Criteria
clinical Criteria
- Confirmed esophageal location with CD117 positivity
Applicable To
- Esophageal GIST
Excludes
- Other esophageal neoplasms
Clinical Validation Requirements
- Pathology report confirming CD117 positivity
- Mitotic rate documentation
Code-Specific Risks
- Misclassification if site is not confirmed
Coding Notes
- Ensure site-specific confirmation through imaging or biopsy.
C49.A1 - Gastrointestinal stromal tumor of stomach
Use for confirmed GISTs located in the stomach with appropriate histological findings.
Applicable To
- Gastric GIST
Excludes
- Other gastric neoplasms
Clinical Validation Requirements
- Histological confirmation of GIST
- CD117 positivity
Coding Notes
Document tumor size and mitotic rate for accurate risk assessment.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Gastrointestinal Stromal Tumor to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C49.A0.
Impact
Clinical: May lead to incorrect diagnosis and treatment, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Ensure CD117 status is included in pathology reports, Cross-check with immunohistochemistry results
Impact
Reimbursement: Potential denial of claims due to lack of specificity, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate data for clinical research and statistics
Mitigation Strategy
Ensure site-specific documentation through imaging or biopsy reports.
Impact
Failure to document the specific site of GIST can lead to audit issues.
Mitigation Strategy
Ensure thorough documentation of tumor location in all reports.
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 Gastrointestinal Stromal Tumor, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gastrointestinal Stromal Tumor
Use these documentation templates to ensure complete and accurate documentation for Gastrointestinal Stromal Tumor. These templates include all required elements for proper coding and billing.
Pathology report for GIST
Specialty: PathologyRequired Elements
- Tumor location
- Tumor size
- Mitotic rate
- CD117 status
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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