⚕️ICD-10 CM C54.1 - Malignant neoplasm of endometrium

Code Description

ICD-10 CM C54.1 represents Malignant neoplasm of endometrium. This code is used to classify a primary cancerous tumor originating in the endometrial lining of the corpus uteri. It is the most common type of uterine cancer, often diagnosed in postmenopausal women.^{CMS ICD-10}

Clinical Overview

Endometrial cancer arises from the lining of the uterus. The most common symptom is abnormal vaginal bleeding, particularly in postmenopausal women. Risk factors include obesity, unopposed estrogen therapy, tamoxifen use, and Lynch syndrome. Diagnosis is typically confirmed via endometrial biopsy. Treatment may involve hysterectomy, radiation, chemotherapy, or hormonal therapy depending on the stage.^NCI

Coding Hierarchy (Code Tree)

This code exists within the following hierarchy in the ICD-10-CM structure:

Chapter II: Neoplasms (C00 - D49)
- Block: Malignant neoplasms of female genital organs (C51-C58)
  - Category: Malignant neoplasm of corpus uteri (C54)
    - Subcategory: Malignant neoplasm of endometrium (C54.1)

Official Coding Guidelines & Notes

Includes

This code includes conditions specified as:

Carcinoma of endometrium
Endometrial cancer
Malignant tumor of endometrium^{WHO ICD-10}

Excludes1

Note: Excludes1 means “not coded here”. If the patient has this condition, do not use C54.1. Code the excluded condition instead.

Carcinoma in situ of corpus uteri (D07.0)
Malignant neoplasm of isthmus uteri (C54.0)
Malignant neoplasm of myometrium (C54.2)^{CMS ICD-10}

Excludes2

Note: Excludes2 means “not included here”. The patient may have both conditions, but code separately.

None specifically listed at this subcategory level. Refer to parent code C54 for broader exclusions.^{CMS ICD-10}

Coding Tips

Histology: If the histology is known (e.g., adenocarcinoma), it is not coded separately unless required by specific registry reporting, as C54.1 implies malignancy. However, morphology codes (M-codes) may be used for cancer registry purposes.^{Coding Clinic}
Metastasis: If the cancer has metastasized to other sites, code the secondary malignancy (e.g., C78.7 Secondary malignant neoplasm of liver) in addition to the primary C54.1.
Personal History: If the patient is seen for follow-up after completed treatment and there is no evidence of disease, use Z85.42 (Personal history of malignant neoplasm of uterus) instead of C54.1.^{CMS ICD-10}
Acquired Absence: If the uterus has been removed, assign Z90.71 (Acquired absence of uterus) as an additional code if relevant to the encounter.^{CMS ICD-10}

Reimbursement & Risk Adjustment

HCC (Hierarchical Condition Category)

Status: Yes
Model: CMS-HCC V28 (2024 Model)
Category: This code maps to HCC categories related to Solid Tumors / Malignant Neoplasms.^{CMS Risk Adjustment}
Impact: Accurate documentation of C54.1 is critical for Medicare Advantage plans. Active cancer significantly increases the Risk Adjustment Factor (RAF) score due to the high cost of treatment and management.

wRVU (Work Relative Value Unit)

Value: N/A
Reason: C54.1 is an ICD-10-CM diagnosis code. wRVU values are assigned to CPT/HCPCS procedure codes (e.g., 58571), not diagnosis codes.^{AMA CPT}

Assistant Surgeon Payable

Status: N/A
Reason: Assistant surgeon modifiers (e.g., -80, -81, -82) apply to surgical CPT codes. Diagnosis codes do not have assistant payable status.^{CMS MPFS}

Applicability: Yes
Impact: C54.1 influences DRG assignment when used as a principal or secondary diagnosis in inpatient settings.
MDC: Typically falls under MDC 13 (Diseases and Disorders of the Female Reproductive System).
DRGs: May assign to DRG 741-743 (Ovarian & Adnexal Malignancy) if adnexa are involved, or Medical Oncology DRGs (820-822) if admitted for chemotherapy, or Radiation Oncology DRGs (823-825). Specific assignment depends on procedures performed and complications.^{CMS MS-DRG}
CC/MCC: The presence of this code often triggers CC/MCC logic depending on comorbidities like malnutrition or sepsis.

Coding Examples

Example 1: Initial Diagnosis and Surgery

Scenario: A patient presents with postmenopausal bleeding. Biopsy confirms endometrial adenocarcinoma. Patient undergoes total laparoscopic hysterectomy.

Principal Diagnosis: C54.1 (Malignant neoplasm of endometrium)
Procedure: 58571 (Laparoscopy, surgical; with total hysterectomy)
Note: Ensure pathology report supports the diagnosis.^{Coding Clinic}

Example 2: Chemotherapy Administration

Scenario: Patient with known C54.1 presents for outpatient infusion of carboplatin and paclitaxel.

Principal Diagnosis: C54.1 (Malignant neoplasm of endometrium)
Procedure: 96413 (Chemotherapy administration, intravenous infusion technique)
Procedure: J9000 (Injection, doxorubicin hydrochloride) - Example drug code
Note: Primary diagnosis should be the malignancy being treated.^{CMS ICD-10}

Example 3: Surveillance Follow-Up

Scenario: Patient treated for endometrial cancer 2 years ago, currently disease-free, presents for routine pelvic exam.

Principal Diagnosis: Z85.42 (Personal history of malignant neoplasm of uterus)
Secondary Diagnosis: Z90.71 (Acquired absence of uterus)
Procedure: 99213 (Office visit)
Note: Do not use C54.1 if the cancer is no longer present.^{CMS ICD-10}

While C54.1 does not use modifiers, associated E/M or Procedure codes might:

-58: Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period.
-78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period.
-79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period.
-25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service.
-RT / -LT: Right Side / Left Side (if applicable to related procedures).^{AMA CPT}

Sources

^{CMS ICD-10} Centers for Medicare & Medicaid Services, ICD-10-CM Official Guidelines for Coding and Reporting. ^NCI National Cancer Institute, Endometrial Cancer Treatment (PDQ®). ^{WHO ICD-10} World Health Organization, ICD-10 Version:2019. ^{Coding Clinic} AHA Coding Clinic for ICD-10-CM/PCS. ^{CMS Risk Adjustment} CMS Medicare Advantage Risk Adjustment Data Processing System. ^{AMA CPT} American Medical Association, CPT Professional Edition. ^{CMS MPFS} CMS Medicare Physician Fee Schedule. ^{CMS MS-DRG} CMS Medicare Severity Diagnosis Related Groups Definitions Manual.

Explorer

C54.1