ICD-10 Coding for Wilms Tumor(C64.1, C64.2, C64.9)
Complete ICD-10-CM coding and documentation guide for Wilms Tumor. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Wilms Tumor
C64-C68Primary Range
Malignant neoplasms of urinary tract
Includes codes for malignant neoplasms of the kidney, which encompasses Wilms tumor.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C64.1 | Malignant neoplasm of right kidney, except renal pelvis | Use when Wilms tumor is confirmed in the right kidney. |
|
| C64.2 | Malignant neoplasm of left kidney, except renal pelvis | Use when Wilms tumor is confirmed in the left kidney. |
|
| C64.9 | Malignant neoplasm of unspecified kidney, except renal pelvis | Use when laterality is not specified or for bilateral involvement. |
|
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 Wilms tumor
Essential facts and insights about Wilms Tumor
Primary ICD-10-CM Codes for wilms tumor
Decision Criteria
clinical Criteria
- Confirmed right kidney involvement
Applicable To
- Right kidney Wilms tumor
Excludes
- Renal pelvis tumors (C65._)
Clinical Validation Requirements
- Imaging confirmation of right renal mass
- Histological confirmation of Wilms tumor
Code-Specific Risks
- Incorrect laterality documentation
Coding Notes
- Ensure laterality is documented accurately.
C64.2 - Malignant neoplasm of left kidney, except renal pelvis
Use when Wilms tumor is confirmed in the left kidney.
Applicable To
- Left kidney Wilms tumor
Excludes
- Renal pelvis tumors (C65._)
Clinical Validation Requirements
- Imaging confirmation of left renal mass
- Histological confirmation of Wilms tumor
Coding Notes
Ensure laterality is documented accurately.
C64.9 - Malignant neoplasm of unspecified kidney, except renal pelvis
Use when laterality is not specified or for bilateral involvement.
Applicable To
- Bilateral Wilms tumor
- Unspecified laterality
Excludes
- Renal pelvis tumors (C65._)
Clinical Validation Requirements
- Imaging confirmation of renal mass
- Histological confirmation of Wilms tumor
Coding Notes
Document laterality if known to avoid unspecified coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Secondary malignant neoplasm of other specified sites
C79.8Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Malignant neoplasm of right renal pelvis
C65.1Malignant neoplasm of left renal pelvis
C65.2Malignant neoplasm of unspecified renal pelvis
C65.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Wilms Tumor to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C64.1.
Impact
Clinical: May affect treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Always document laterality in clinical notes., Cross-check with imaging reports.
Impact
Reimbursement: May result in lower reimbursement due to unspecified coding., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases specificity and accuracy of health records.
Mitigation Strategy
Use C64.1 or C64.2 when laterality is specified.
Impact
Failure to document laterality can lead to audit discrepancies.
Mitigation Strategy
Implement mandatory laterality documentation checks.
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 Wilms Tumor, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Wilms Tumor
Use these documentation templates to ensure complete and accurate documentation for Wilms Tumor. These templates include all required elements for proper coding and billing.
Wilms Tumor Diagnosis
Specialty: Pediatric OncologyRequired Elements
- Tumor laterality
- Histological type
- Staging information
- Metastatic sites
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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