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MA08.123d
A
MA08.123d
ICD-10 Codes and Narratives
Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®)


DURVALUMAB (IMFINZI®) IS MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING DIAGNOSIS CODES:

C22.0Liver cell carcinoma
C22.1
Intrahepatic bile duct carcinoma
C22.7
Other specified carcinomas of liver
C22.8
Malignant neoplasm of liver, primary, unspecified as to type
C22.9
Malignant neoplasm of liver, not specified as primary or secondary​
C23  
Malignant neoplasm of gallbladder
C24.0
Malignant neoplasm of extrahepatic bile duct
C24.1Malignant neoplasm of ampulla of Vater
C24.8
Malignant neoplasm of overlapping sites of biliary tract
C24.9
Malignant neoplasm of biliary tract, unspecified​
C33 
Malignant neoplasm of trachea
C34.01Malignant neoplasm of right main bronchus
C34.02Malignant neoplasm of left main bronchus
C34.11Malignant neoplasm of upper lobe, right bronchus or lung
C34.12Malignant neoplasm of upper lobe, left bronchus or lung
C34.2Malignant neoplasm of middle lobe, bronchus or lung
C34.31Malignant neoplasm of lower lobe, right bronchus or lung
C34.32Malignant neoplasm of lower lobe, left bronchus or lung
C34.81Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82Malignant neoplasm of overlapping sites of left bronchus and lung
C34.91Malignant neoplasm of unspecified part of right bronchus or lung
C34.92Malignant neoplasm of unspecified part of left bronchus or lung
C45.0Mesothelioma of pleura
C53.0Malignant neoplasm of endocervix
C53.1Malignant neoplasm of exocervix
C53.8Malignant neoplasm of overlapping sites of cervix uteri
C53.9Malignant neoplasm of cervix uteri, unspecified​
C7A.1
​Malignant poorly differentiated neuroendocrine tumors
D06.0Carcinoma in situ of endocervix
D06.1Carcinoma in situ of exocervix
D06.7Carcinoma in situ of other parts of cervix
D06.9Carcinoma in situ of cervix, unspecified


TREMELIMUMAB-ACT (IMJUDO®)​ IN CONJUCTION WITH DURVALUMAB (IMFINZI®​) IS MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING DIAGNOSIS CODES:

​​C15.3
​Malignant neoplasm of upper third of esophagus
​C15.4
​Malignant neoplasm of middle third of esophagus
​C15.5
​Malignant neoplasm of lower third of esophagus
​C15.8
​Malignant neoplasm of overlapping sites of esophagus
​C15.9
​Malignant neoplasm of esophagus, unspecified
​​C16.0
​Malignant neoplasm of cardia​​
​C16.1
​Malignant neoplasm of fundus of stomach
​C16.2
​Malignant neoplasm of body of stomach
​C16.3
​Malignant neoplasm of pyloric antrum
​C16.4
​Malignant neoplasm of pylorus
​C16.5
​Malignant neoplasm of lesser curvature of stomach, unspecified
​C16.6
​Malignant neoplasm of greater curvature of stomach, unspecified
​​​​C16.8
​Malignant neoplasm of overlapping sites of stomach
​​C16.9
​Malignant neoplasm of stomach, unspecified
C22.0Liver cell carcinoma
​C22.7
Other specified carcinomas of liver
C22.8
Malignant neoplasm of liver, primary, unspecified as to type
C22.9
Malignant neoplasm of liver, not specified as primary or secondary​
C33
​​Malignant neoplasm of trachea
C34.01Malignant neoplasm of right main bronchus
C34.02Malignant neoplasm of left main bronchus
C34.11Malignant neoplasm of upper lobe, right bronchus or lung
C34.12Malignant neoplasm of upper lobe, left bronchus or lung
C34.2Malignant neoplasm of middle lobe, bronchus or lung
C34.31Malignant neoplasm of lower lobe, right bronchus or lung
C34.32Malignant neoplasm of lower lobe, left bronchus or lung
C34.81Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82Malignant neoplasm of overlapping sites of left bronchus and lung​
C34.91Malignant neoplasm of unspecified part of right bronchus or lung
C34.92Malignant neoplasm of unspecified part of left bronchus or lung​​




05/06/2024
05/06/2024
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