2025 ICD-10-CM code R97.1
Elevated cancer antigen 125 [CA 125]. This code signifies an abnormally high level of the cancer antigen 125, a protein often associated with certain cancers, particularly ovarian cancer.
Medical necessity for the CA 125 test is established when there is a clinical suspicion of a condition that may cause an elevation in CA 125 levels, such as ovarian cancer, other pelvic malignancies, or benign conditions like endometriosis. It can also be used for monitoring the course of these conditions.
The clinician is responsible for ordering the CA 125 test, interpreting the results in conjunction with other clinical findings, and determining the appropriate next steps for diagnosis and management.This may involve further investigations such as imaging studies or consultation with specialists.
- R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
- Abnormal tumor markers (R97-R97.8)
In simple words: A blood test showed a higher-than-normal level of a protein called CA 125.This protein can sometimes be a sign of cancer, especially ovarian cancer, but it can also be high due to other reasons. More tests are needed to figure out why the level is high.
Elevated cancer antigen 125 [CA 125].An elevated CA 125 level can be an indicator of various conditions, including ovarian cancer, but it's not specific to this cancer and can be elevated in other conditions like endometriosis, pelvic inflammatory disease, and even during pregnancy. Further investigation is needed to determine the clinical significance of an elevated CA 125.
Example 1: A 55-year-old woman presents with abdominal bloating and discomfort. A pelvic exam reveals an ovarian mass. A CA 125 test is ordered, and the result is significantly elevated (e.g., >35 U/mL). This finding, combined with the clinical presentation, raises suspicion for ovarian cancer, prompting further investigation with imaging and possible biopsy., A 30-year-old woman with known endometriosis experiences worsening pelvic pain.A CA 125 test is ordered to monitor her condition. The result shows a moderately elevated CA 125 level. This elevation is attributed to the underlying endometriosis and does not necessarily indicate malignancy.The clinician continues to manage her endometriosis with existing treatment plans., A 60-year-old woman undergoing chemotherapy for breast cancer has routine blood work, which includes a CA 125 test. The result is mildly elevated. The clinician evaluates for other potential causes of the elevation, such as inflammation or infection, before considering any changes to the cancer treatment plan.
Documentation should include the reason for ordering the CA 125 test (e.g., symptoms, monitoring), the numerical result of the test, the units of measurement (typically U/mL), the interpretation of the result in the context of other clinical findings, and the plan for further investigation or management.
** CA 125 is not a diagnostic test for ovarian cancer on its own.It's essential to consider the result alongside other clinical information, such as symptoms, physical exam findings, and imaging studies, to reach a diagnosis.Refer to the iFrameAI product for additional information.
- Specialties:Gynecology, Oncology, Internal Medicine, Family Medicine
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Independent Clinic, Independent Laboratory