Is ICD-10-CM code D43 billable?

No, D43 (Neoplasm of uncertain behavior of brain and central nervous system) 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 D43 belong to?

D43 belongs to Chapter 2 of the ICD-10-CM tabular list: C00–D49 (Neoplasms).

D43Not billable, use a more specific code below

Neoplasm of uncertain behavior of brain and central nervous system

In Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48), chapter 2: Neoplasms

7 billable codes under D43: none are a CC or MCC; all map to HCC 23 (Prostate, Breast, and Other Cancers and Tumors).An HCC counts toward a Medicare Advantage patient's risk score.

Instructional notes

Excludes1: not coded here, use a different code

neoplasm of uncertain behavior of peripheral nerves and autonomic nervous system (D48.2)

Also applies, from Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48)

These notes sit on D37-D48 and apply to every code under it, including D43.

Excludes1: not coded here, use a different code

neoplasms of unspecified behavior (D49.-)

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 D43

D43 can't be used on a claim. Pick a billable code below; grey headings group them.

D43 MS-DRGs

As the principal diagnosis, all 7 billable codes under D43 group to MS-DRG 054 or 055 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

About the condition

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

Brain Diseases

Your brain is the control center of your body. It controls your thoughts, memory, speech, and movement. It regulates the function of many organs. It's part of your nervous system, which also includes your spinal cord and peripheral nerves. The nervous system sends signals between your brain and the rest of the body. Your nerves take in information from your senses and send it to the brain to be processed. Your brain and nerves also communicate to help you move and to control your body's functions.

Code history

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