Is C25.4 a billable ICD-10-CM code?

Yes. C25.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does C25.4 sit in the tabular list?

Neoplasms (C00-D49), in the block Malignant neoplasms of digestive organs (C15-C26).

C25.4

C25.4 — Malignant neoplasm of endocrine pancreas

Billable / specific codeICD-10-CM

C25.4 is a billable, specific ICD-10-CM code for malignant neoplasm of endocrine pancreas. It is valid for submission on a claim.

Use additional code

Add a secondary code to capture the detail described below.

code to identify any functional activity.

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Malignant neoplasm of islets of Langerhans

Other codes that can never be billed with C25.4

These codes carry an Excludes1 note pointing at C25.4. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading C25.4 alone.

C75Malignant neoplasm of other endocrine glands and related structures

Risk adjustment

C25.4 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 20 Lung and Other Severe Cancers1.136 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

C25.4 is named in 88 Medicare coverage policies — 88 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52479Oral Anticancer Drugs - Policy Article
A52479Oral Anticancer Drugs - Policy Article
A52479Oral Anticancer Drugs - Policy Article
A52479Oral Anticancer Drugs - Policy Article

How C25.4 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to C25.4.

Adenocarcinoma›islet cell›pancreas
Adenocarcinoma›islet cell›unspecified site
Carcinoma›islet cell›pancreas
Carcinoma›islet cell›unspecified site
Gastrinoma›malignant›pancreas
Gastrinoma›malignant›unspecified site
Glucagonoma›pancreas›malignant
Glucagonoma›unspecified site›malignant
Insulinoma›pancreas›malignant
Insulinoma›unspecified site›malignant
Tumor›alpha-cell›malignant›pancreas
Tumor›alpha-cell›malignant›unspecified site

Related codes at this level

Codes that share C25. If C25.4 is not quite right, the correct code is usually one of these.

Questions about C25.4

Is C25.4 a billable ICD-10-CM code?: Yes. C25.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does C25.4 sit in the tabular list?: Neoplasms (C00-D49), in the block Malignant neoplasms of digestive organs (C15-C26).