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2025 ICD-10-CM code D37

Neoplasm of uncertain behavior of the oral cavity and digestive organs.

Do not assign a code until a definitive diagnosis is made. If a more specific code becomes available after further testing, the original D37 code should be replaced. An unspecified code should only be used as a last resort if no further information can be obtained.

Medical necessity for services related to D37 is established by the uncertainty of the diagnosis and the need for further investigation to determine the appropriate treatment. Documentation should clearly justify the need for additional testing or procedures to establish a definitive diagnosis.

Diagnosis of D37 involves physical examination, imaging studies (ultrasound, CT, MRI, PET), and biopsy. Treatment varies depending on the final diagnosis and may include surgery, radiation therapy, or chemotherapy. The provider is responsible for determining the best course of treatment after a definitive diagnosis is reached.Close follow-up and supportive care are crucial until a definitive diagnosis is made.

In simple words: This code is used when a growth is found in the mouth or digestive system, and doctors aren't sure yet if it's cancerous or not. More tests are needed to figure out what kind of growth it is.

This code represents a neoplasm in the oral cavity or digestive organs where it is uncertain whether the neoplasm is benign or malignant based on histologic examination. The oral cavity includes lips, buccal mucosa, gums, oral mucosa, hard palate, teeth, and the front two-thirds of the tongue. Digestive organs include the pharynx, esophagus, stomach, small intestine, large intestine, rectum, liver, pancreas, and gallbladder.

Example 1: A patient presents with a persistent sore throat and difficulty swallowing. A biopsy of the affected area reveals a growth, but the pathologist cannot definitively classify it as benign or malignant. D37 is assigned until further testing can be done., During a routine colonoscopy, a polyp is discovered. Biopsy results are inconclusive, indicating a neoplasm of uncertain behavior. D37 is used until additional testing, such as immunohistochemical staining, can be performed., An ulcer on the tongue fails to heal after several weeks. A biopsy is taken, and the pathology report describes a neoplasm with features of both benign and malignant tumors. D37 is assigned, and the patient is scheduled for further evaluation and possible surgical excision.

Documentation should include details of the patient's presenting symptoms, location and description of the neoplasm, results of imaging studies and biopsy, and plan for further investigation or treatment. The uncertainty of the diagnosis based on the initial histologic examination should be clearly documented.

** It is crucial to follow up on the final pathology report for a definitive diagnosis. This code should be updated when the definitive diagnosis is determined.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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