C38.0: Malignant neoplasm of heart
C38.0 is a billable, specific ICD-10-CM code for malignant neoplasm of heart. It is valid for submission on a claim.
Check C38.0 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- malignant neoplasm of great vessels (C49.3)
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Malignant neoplasm of pericardium
Other codes that can never be billed with C38.0
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
C38.0 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
C38.0 is named in 58 Medicare coverage policies: 58 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
- A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
- A52868Billing and Coding: Transesophageal Echocardiography (TEE)
Code history
Unchanged in every release from FY2024 to FY2027.