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Desmoid Tumor in ICD-10-CM: Coding For This Noncancerous Growth

Desmoid tumor in ICD-10-CM
Request for biopsy results to confirm a desmoid tumor
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Name That Code!

Question: A 37-year-old female presents with gradually increasing swelling in the left upper leg. She has a mild, dull, aching pain in the leg. After imaging and biopsy results were obtained, the patient was diagnosed with an extra-abdominal desmoid tumor. She is placed on active surveillance. Assign for ICD-10-CM.

Answer:

D48.116, Desmoid tumor of lower extremity and pelvic girdle

Understanding Extra-Abdominal Desmoid Tumor

According to Cancer.Net, an extra-abdominal desmoid tumor, defined as a desmoid tumor outside the abdomen, primarily affects areas such as the shoulder, upper arms, chest wall, upper legs, and occasionally the head or neck. In this case, the tumor is located in the left upper leg.

ICD-10-CM Coding Guidelines

As the ICD-10-CM Official Guidelines for Coding and Reporting indicate, to accurately code a neoplasm, understanding its behavior (benign, malignant, in-situ, or uncertain) is crucial. The Alphabetic Index guides us to relevant terms, and the Neoplasm Table provides the proper code based on type and site.

Locate and Verify

Desmoid tumor in ICD-10-CM

In the Alphabetic Index, we can search for “Tumor/desmoid (extra-abdominal).” This leads us to “Neoplasm, connective tissue, uncertain behavior.” Following the table, we can verify the correct code as:

D48.116, Desmoid tumor of lower extremity and pelvic girdle

Expanded Code Categories

As of October 1, 2023, a new subcategory code was added: D48.11, Desmoid Tumor. Also, at the same time, nine new codes were added to describe the anatomical site of the tumor, which provides higher specificity.

As presented in the image above, the new codes are:

  • D48.111, Desmoid tumor of chest wall 
  • D48.112, Desmoid tumor, intrathoracic
  • D48.113, Desmoid tumor of abdominal wall
  • D48.114, Desmoid tumor, intraabdominal
    Desmoid tumor of pelvic cavity
    Desmoid tumor, peritoneal, retroperitoneal
  • D48.115, Desmoid tumor of upper extremity and shoulder girdle
  • D48.116, Desmoid tumor of lower extremity and pelvic girdle
    Desmoid tumor of buttock
  • D48.117, Desmoid tumor of back
  • D48.118, Desmoid tumor of other site
  • D48.119, Desmoid tumor of unspecified site

The Use of “And”

Despite the tumor being in the left upper leg, D48.116 is appropriate per the ICD-10-CM guidelines. The use of “and” in the title allows reporting for either the lower extremity, pelvic girdle, or both locations.

Coding for Signs and Symptoms

With a confirmed diagnosis of an extra-abdominal desmoid tumor, coding for associated signs and symptoms, such as swelling and pain, is unnecessary. Additional codes for signs and symptoms should only be assigned when explicitly instructed otherwise by the classification or when they are not routinely associated with the disease process. That is why coders must know the pathology of these tumors to ensure accurate coding. If there are any uncertainties about the associated signs and symptoms, the coder may need to query the provider.

Facts About Desmoid Tumors 

Desmoid tumors, also known as desmoid-type fibromatosis or aggressive fibromatosis, are rare soft-tissue tumors associated with sarcomas. They typically do not metastasize but require careful diagnosis and treatment planning. Diagnosing a desmoid tumor is usually done through clinical examinations and imaging tests, with a biopsy test performed to confirm the diagnosis. Treatment options include active surveillance, surgery, radiation therapy, cryosurgery, radiofrequency thermal ablation (RFA), and medications.

desmoid tumor in ICD-10-CM
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