C25.9 — Malignant neoplasm of pancreas, unspecified
C25.9 is a billable, specific ICD-10-CM code for malignant neoplasm of pancreas, unspecified. It is valid for submission on a claim.
Risk adjustment
C25.9 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.
Medicare coverage
C25.9 is named in 66 Medicare coverage policies — 66 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
- A52479Oral Anticancer Drugs - Policy Article
- A52479Oral Anticancer Drugs - Policy Article
- A52479Oral Anticancer Drugs - Policy Article
How C25.9 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to C25.9.
- Adenocarcinoma›islet cell›with exocrine, mixed›unspecified site
- Carcinoma›islet cell›with exocrine, mixed›unspecified site
Related codes at this level
Codes that share C25. If C25.9 is not quite right, the correct code is usually one of these.
- C25.0Malignant neoplasm of head of pancreas
- C25.1Malignant neoplasm of body of pancreas
- C25.2Malignant neoplasm of tail of pancreas
- C25.3Malignant neoplasm of pancreatic duct
- C25.4Malignant neoplasm of endocrine pancreas
- C25.7Malignant neoplasm of other parts of pancreas
- C25.8Malignant neoplasm of overlapping sites of pancreas
Questions about C25.9
- Is C25.9 a billable ICD-10-CM code?
- Yes. C25.9 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does C25.9 sit in the tabular list?
- Neoplasms (C00-D49), in the block Malignant neoplasms of digestive organs (C15-C26).