D43.1

D43.1: Neoplasm of uncertain behavior of brain, infratentorial

Billable / specific codeICD-10-CM

D43.1 is a billable, specific ICD-10-CM code for neoplasm of uncertain behavior of brain, infratentorial. It is valid for submission on a claim.

Check D43.1 with the rest of the claim: free scrubber

Inclusion terms

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

Neoplasm of uncertain behavior of brain stem
Neoplasm of uncertain behavior of cerebellum
Neoplasm of uncertain behavior of fourth ventricle

Excludes1 inherited from the categories above D43.1

A category’s note binds every code beneath it.

Written on D43: Neoplasm of uncertain behavior of brain and central nervous system

neoplasm of uncertain behavior of peripheral nerves and autonomic nervous system (D48.2)

Other codes that can never be billed with D43.1

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

D43.0Neoplasm of uncertain behavior of brain, supratentorial

Risk adjustment

D43.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 23 Prostate, Breast, and Other Cancers and Tumors0.186 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

D43.1 is named in 33 Medicare coverage policies: 33 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.