D43.4
D43.4 — Neoplasm of uncertain behavior of spinal cord
Billable / specific codeICD-10-CM
D43.4 is a billable, specific ICD-10-CM code for neoplasm of uncertain behavior of spinal cord. It is valid for submission on a claim.
Risk adjustment
D43.4 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.
Medicare coverage
D43.4 is named in 38 Medicare coverage policies — 38 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52370Billing and Coding: Bevacizumab and biosimilars
- A52479Oral Anticancer Drugs - Policy Article
- A52479Oral Anticancer Drugs - Policy Article
- A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
Related codes at this level
Codes that share D43. If D43.4 is not quite right, the correct code is usually one of these.
- D43.0Neoplasm of uncertain behavior of brain, supratentorial
- D43.1Neoplasm of uncertain behavior of brain, infratentorial
- D43.2Neoplasm of uncertain behavior of brain, unspecified
- D43.3Neoplasm of uncertain behavior of cranial nerves
- D43.8Neoplasm of uncertain behavior of other specified parts of central nervous system
- D43.9Neoplasm of uncertain behavior of central nervous system, unspecified
Questions about D43.4
- Is D43.4 a billable ICD-10-CM code?
- Yes. D43.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does D43.4 sit in the tabular list?
- Neoplasms (C00-D49), in the block Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48).