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.

Check D12.1 with the rest of the claim: free scrubber

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)

Excludes2 inherited from the categories above D12.1

Not part of this code, but both may be coded when both are present.

Written on D12: Benign neoplasm of colon, rectum, anus and anal canal

benign carcinoid tumors of the large intestine and rectum (D3A.02-)
polyp of colon NOS (K63.5)

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

D12.1 is named in 16 Medicare coverage policies: 16 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

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

Code history

Unchanged in every release from FY2024 to FY2027.