D12.1
D12.1 — Benign neoplasm of appendix
Billable / specific codeICD-10-CM
D12.1 is a billable, specific ICD-10-CM code for benign neoplasm of appendix. It is valid for submission on a claim.
Excludes1 — never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- benign carcinoid tumor of the appendix (D3A.020)
Risk adjustment
D12.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
D12.1 is named in 18 Medicare coverage policies — 18 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A55937Billing and Coding: Diagnostic Colonoscopy
- A56394Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic
- A56421Billing and Coding: CT of the Abdomen and Pelvis
- A56456Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
Related codes at this level
Codes that share D12. If D12.1 is not quite right, the correct code is usually one of these.
- D12.0Benign neoplasm of cecum
- D12.2Benign neoplasm of ascending colon
- D12.3Benign neoplasm of transverse colon
- D12.4Benign neoplasm of descending colon
- D12.5Benign neoplasm of sigmoid colon
- D12.6Benign neoplasm of colon, unspecified
- D12.7Benign neoplasm of rectosigmoid junction
- D12.8Benign neoplasm of rectum
- D12.9Benign neoplasm of anus and anal canal
Questions about D12.1
- Is D12.1 a billable ICD-10-CM code?
- Yes. D12.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does D12.1 sit in the tabular list?
- Neoplasms (C00-D49), in the block Benign neoplasms, except benign neuroendocrine tumors (D10-D36).
- What cannot be coded together with D12.1?
- D12.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.