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Home/Diagnosis/ICD-10 Coding for Elevated CA-125

ICD-10 Coding for Elevated CA-125

R97.1
C56

Complete ICD-10-CM coding and documentation guide for icd-10 coding for elevated ca-125 includes clinical validation requirements, medical necessity guidelines, and coding policies.

Also Known as:
Elevated Carcinoma Antigen 125
High CA-125 Levels
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Key Information: ICD-10 Coding for Elevated CA-125

Essential facts and insights about ICD-10 Coding for Elevated CA-125

Use ICD-10 code R97.1 for elevated cancer antigen 125 [ca 125], ensuring proper documentation in clinical notes.

Primary ICD-10-CM Codes

Elevated cancer antigen 125 [CA 125]

Billable Code
R97.1
Billable

Diagnostic Criteria

clinical_criteria:
  • • CA-125 level above normal range with clinical suspicion of malignancy
coding_criteria:
  • • Use R97.1 when CA-125 is elevated but no malignancy is confirmed

Applicable To

  • • Elevated CA-125 levels

Important Notes

  • • Ensure clinical documentation supports the use of R97.1, especially in the absence of a confirmed malignancy.

Malignant neoplasm of ovary

Non-Billable
C56
Non-Billable

Applicable To

  • • Ovarian cancer

Important Notes

  • • Ensure that C56 is sequenced before R97.1 when ovarian cancer is confirmed.
Ancillary Codes

Additional codes that may be used with this diagnosis

C56

Malignant neoplasm of ovary

Use when ovarian cancer is confirmed alongside elevated CA-125.

Frequently Asked Questions

What is the ICD-10 code for elevated CA-125?

The ICD-10 code for elevated CA-125 is R97.1. It is used when CA-125 levels are elevated without a confirmed malignancy.

How should elevated CA-125 be documented?

Document the CA-125 level with reference range, clinical context, and any relevant imaging findings to support the diagnosis.

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