Is D38.5 a billable ICD-10-CM code?

Yes. D38.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does D38.5 sit in the tabular list?

Neoplasms (C00-D49), in the block Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48).

What cannot be coded together with D38.5?

D38.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

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.

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

Other codes that can never be billed with D38.5

These codes carry an Excludes1 note pointing at D38.5. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading D38.5 alone.

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

Risk adjustment

D38.5 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

D38.5 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.

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)

Related codes at this level

Codes that share D38. If D38.5 is not quite right, the correct code is usually one of these.

Questions about D38.5

Is D38.5 a billable ICD-10-CM code?: Yes. D38.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does D38.5 sit in the tabular list?: Neoplasms (C00-D49), in the block Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48).
What cannot be coded together with D38.5?: D38.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.