D37-D48 — Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes
ICD-10-CM codes D37-D48 cover neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes, within neoplasms. The block holds 140 codes across 12 categories, of which 115 are billable and 25 are header codes that cannot be submitted on a claim.
Excludes1 — never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- neoplasms of unspecified behavior (D49.-)
Notes
Additional guidance from the ICD-10-CM tabular list.
Risk adjustment in D37-D48
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 23 Prostate, Breast, and Other Cancers and Tumors
- HCC 19 Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers
- HCC 21 Lymphoma and Other Cancers
- HCC 17 Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic
What else to watch in D37-D48
- 14 codes are laterality-specific. They come in left and right pairs, and the pair is mutually exclusive on a single site: coding both without a bilateral code is a contradiction a scrubber should catch before the payer does.
- 115 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.
Categories in D37-D48
- D37Neoplasm of uncertain behavior of oral cavity and digestive organs
- D38Neoplasm of uncertain behavior of middle ear and respiratory and intrathoracic organs
- D39Neoplasm of uncertain behavior of female genital organs
- D40Neoplasm of uncertain behavior of male genital organs
- D41Neoplasm of uncertain behavior of urinary organs
- D42Neoplasm of uncertain behavior of meninges
- D43Neoplasm of uncertain behavior of brain and central nervous system
- D44Neoplasm of uncertain behavior of endocrine glands
- D45Polycythemia vera
- D46Myelodysplastic syndromes
- D47Other neoplasms of uncertain behavior of lymphoid, hematopoietic and related tissue
- D48Neoplasm of uncertain behavior of other and unspecified sites