D49 — Neoplasms of unspecified behavior
ICD-10-CM codes D49 cover neoplasms of unspecified behavior, within neoplasms. The block holds 18 codes across 1 category, of which 14 are billable and 4 are header codes that cannot be submitted on a claim.
Risk adjustment in D49
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
What else to watch in D49
- 2 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.
- 14 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.