C25.4

C25.4: Malignant neoplasm of endocrine pancreas

Billable / specific codeICD-10-CM

C25.4 is a billable, specific ICD-10-CM code for malignant neoplasm of endocrine pancreas. It is valid for submission on a claim.

Check C25.4 with the rest of the claim: free scrubber

Use additional code

Add a secondary code to capture the detail described below.

code to identify any functional activity.

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Malignant neoplasm of islets of Langerhans

Other codes that can never be billed with C25.4

Their own Excludes1 notes name this code, so the conflict is not listed above.

C75Malignant neoplasm of other endocrine glands and related structures

Risk adjustment

C25.4 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 20 Lung and Other Severe Cancers1.136 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

C25.4 is named in 68 Medicare coverage policies: 68 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52479Oral Anticancer Drugs - Policy Article
A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
A54338Billing and Coding: MolDX: Germline testing for use of PARP inhibitors
A54689Billing and Coding: Germline testing for use of PARP inhibitors

Alphabetic index entries that lead here

Adenocarcinoma›islet cell›pancreas
Adenocarcinoma›islet cell›unspecified site
Carcinoma›islet cell›pancreas
Carcinoma›islet cell›unspecified site
Gastrinoma›malignant›pancreas
Gastrinoma›malignant›unspecified site
Glucagonoma›pancreas›malignant
Glucagonoma›unspecified site›malignant
Insulinoma›pancreas›malignant
Insulinoma›unspecified site›malignant
Tumor›alpha-cell›malignant›pancreas
Tumor›alpha-cell›malignant›unspecified site

Code history

Unchanged in every release from FY2024 to FY2027.