Is ICD-10-CM code C38 billable?

No, C38 (Malignant neoplasm of heart, mediastinum and pleura) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code C38 belong to?

C38 belongs to Chapter 2 of the ICD-10-CM tabular list: C00–D49 (Neoplasms).

C38Not billable, use a more specific code below

Malignant neoplasm of heart, mediastinum and pleura

In Malignant neoplasms of respiratory and intrathoracic organs (C30-C39), chapter 2: Neoplasms

6 billable codes under C38: all are a CC; all map to HCC 21 (Lymphoma and Other Cancers), HCC 20 (Lung and Other Severe Cancers).A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment. An HCC counts toward a Medicare Advantage patient's risk score.

Instructional notes

Excludes1: not coded here, use a different code

mesothelioma (C45.-)

Also applies, from Malignant neoplasms of respiratory and intrathoracic organs (C30-C39)

These notes sit on C30-C39 and apply to every code under it, including C38.

Includes: conditions that are coded here

malignant neoplasm of middle ear

Excludes1: not coded here, use a different code

mesothelioma (C45.-)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Rules for coding benign and malignant neoplasms: using the Neoplasm Table, sequencing primary and secondary sites, treatment encounters, complications, and current cancer versus personal history.

Admission/Encounter for treatment of primary site (page 33)
Admission/Encounter for treatment of secondary site (page 33)
Coding and sequencing of complications (page 34)
Primary malignancy previously excised (page 34)
Admissions/Encounters involving antineoplastic chemotherapy, immunotherapy and radiation therapy (page 35)
Admission/encounter to determine extent of malignancy (page 36)
Symptoms, signs, and abnormal findings listed in Chapter 18 associated with neoplasms (page 36)
Admission/encounter for pain control/management (page 36)

Read Section I.C.2 (page 32), 12 more topics

All codes under C38

C38 can't be used on a claim. Pick a billable code below; grey headings group them.

C38 MS-DRGs

As the principal diagnosis, the billable codes under C38 group to these 9 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 180 Respiratory Neoplasms with MCC (5 of 6 codes)
DRG 181 Respiratory Neoplasms with CC (5 of 6 codes)
DRG 182 Respiratory Neoplasms without CC/MCC (5 of 6 codes)
DRG 146 Ear, Nose, Mouth and Throat Malignancy with MCC (1 of 6 codes)
DRG 147 Ear, Nose, Mouth and Throat Malignancy with CC (1 of 6 codes)
DRG 148 Ear, Nose, Mouth and Throat Malignancy without CC/MCC (1 of 6 codes)
DRG 314 Other Circulatory System Diagnoses with MCC (1 of 6 codes)
DRG 315 Other Circulatory System Diagnoses with CC (1 of 6 codes)
DRG 316 Other Circulatory System Diagnoses without CC/MCC (1 of 6 codes)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Cancer

Cancer is not just one disease but many diseases. Cancer begins in your cells, which are the building blocks of your body. Usually, your body forms new cells as needed, replacing old cells that die. Sometimes this process goes wrong. New cells grow even when you don't need them, and old cells don't die when they should. These extra cells can form a mass called a tumor.

Heart Diseases

Heart disease is a general term that includes many types of heart problems. It's a type of cardiovascular disease, which means heart and blood vessel disease.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.