C38.4
C38.4: Malignant neoplasm of pleura
Billable / specific codeICD-10-CM
C38.4 is a billable, specific ICD-10-CM code for malignant neoplasm of pleura. It is valid for submission on a claim.
Check C38.4 with the rest of the claim: free scrubberOther codes that can never be billed with C38.4
Their own Excludes1 notes name this code, so the conflict is not listed above.
- C45.0Mesothelioma of pleura
Risk adjustment
C38.4 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
C38.4 is named in 64 Medicare coverage policies: 64 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
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Code history
Unchanged in every release from FY2024 to FY2027.