C45-C49 — Malignant neoplasms of mesothelial and soft tissue
ICD-10-CM codes C45-C49 cover malignant neoplasms of mesothelial and soft tissue, within neoplasms. The block holds 63 codes across 5 categories, of which 52 are billable and 11 are header codes that cannot be submitted on a claim.
Risk adjustment in C45-C49
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 21 Lymphoma and Other Cancers
- HCC 23 Prostate, Breast, and Other Cancers and Tumors
- HCC 19 Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers
- HCC 20 Lung and Other Severe Cancers
What else to watch in C45-C49
- 10 codes are laterality-specific. They come in left and right pairs, and the pair is mutually exclusive on a single site: coding both without a bilateral code is a contradiction a scrubber should catch before the payer does.
- 52 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.