ICD-10 Coding for Pancreatic Neuroendocrine Tumor(C25.4, C7A.094)
Complete ICD-10-CM coding and documentation guide for Pancreatic Neuroendocrine Tumor. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pancreatic Neuroendocrine Tumor
C25.0-C25.9Primary Range
Malignant neoplasm of pancreas
Primary range for pancreatic neuroendocrine tumors, specifying site-specific malignancies.
Malignant neuroendocrine tumor of foregut
Used for foregut neuroendocrine tumors when pancreatic origin is not confirmed.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C25.4 | Malignant neoplasm of endocrine pancreas | Use for nonfunctional pancreatic neuroendocrine tumors with confirmed pancreatic origin. |
|
| C7A.094 | Malignant neuroendocrine tumor of foregut | Use for foregut neuroendocrine tumors when pancreatic origin is not confirmed. |
|
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 pancreatic neuroendocrine tumor
Essential facts and insights about Pancreatic Neuroendocrine Tumor
Primary ICD-10-CM Codes for pancreatic neuroendocrine tumor
Decision Criteria
clinical Criteria
- Nonfunctional tumor with confirmed pancreatic origin.
Applicable To
- Nonfunctional pancreatic neuroendocrine tumors
Excludes
- Functional pancreatic neuroendocrine tumors
Clinical Validation Requirements
- Nonfunctional tumors, incidental findings on imaging, elevated chromogranin A/synaptophysin
Code-Specific Risks
- Incorrectly coding functional tumors under this code.
Coding Notes
- Ensure documentation specifies nonfunctional status and pancreatic origin.
C7A.094 - Malignant neuroendocrine tumor of foregut
Use for foregut neuroendocrine tumors when pancreatic origin is not confirmed.
Applicable To
- Foregut neuroendocrine tumors not otherwise specified
Excludes
- Pancreatic neuroendocrine tumors
Clinical Validation Requirements
- Tumor involves foregut structures, pancreatic origin not confirmed.
Coding Notes
Verify anatomical origin before coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Carcinoid syndrome
E34.0Differential 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 Pancreatic Neuroendocrine Tumor to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C25.4.
Impact
Clinical: Impacts treatment decisions and prognosis., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to insufficient documentation.
Mitigation Strategy
Ensure pathology reports include tumor grade and Ki-67 index., Educate staff on documentation standards.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Use C25.4 for pancreatic-origin NETs, not C7A.094.
Impact
Risk of selecting incorrect primary code for pancreatic NETs.
Mitigation Strategy
Regular training on code differentiation and documentation requirements.
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 Pancreatic Neuroendocrine Tumor, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pancreatic Neuroendocrine Tumor
Use these documentation templates to ensure complete and accurate documentation for Pancreatic Neuroendocrine Tumor. These templates include all required elements for proper coding and billing.
Pathology Report for Nonfunctional PNET
Specialty: PathologyRequired Elements
- Tumor size
- Histological grade
- Functionality status
- Immunohistochemistry results
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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