D38.5

D38.5: Neoplasm of uncertain behavior of other respiratory organs

Billable / specific codeICD-10-CM

D38.5 is a billable, specific ICD-10-CM code for neoplasm of uncertain behavior of other respiratory organs. It is valid for submission on a claim.

Check D38.5 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.

neoplasm of uncertain behavior of ear (external) (skin) (D48.5)
neoplasm of uncertain behavior of nose NOS (D48.7)
neoplasm of uncertain behavior of skin of nose (D48.5)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Neoplasm of uncertain behavior of accessory sinuses
Neoplasm of uncertain behavior of cartilage of nose
Neoplasm of uncertain behavior of middle ear
Neoplasm of uncertain behavior of nasal cavities

Excludes1 inherited from the categories above D38.5

A category’s note binds every code beneath it.

Written on D38: Neoplasm of uncertain behavior of middle ear and respiratory and intrathoracic organs

neoplasm of uncertain behavior of heart (D48.7)

Other codes that can never be billed with D38.5

Their own Excludes1 notes name this code, so the conflict is not listed above.

D48.0Neoplasm of uncertain behavior of bone and articular cartilage
D48.1Neoplasm of uncertain behavior of connective and other soft tissue

Risk adjustment

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

Medicare coverage

D38.5 is named in 16 Medicare coverage policies: 16 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
A55717Billing and Coding: Lab: Flow Cytometry
A56462Billing and Coding: Erythropoiesis Stimulating Agents (ESA)

Code history

Unchanged in every release from FY2024 to FY2027.