C38.4
BillableMalignant neoplasm of pleura
HCC Category Mapping
V28HCC 20 — Lung and Other Severe Cancers
0.000V24HCC 9 — Lung and Other Severe Cancers
0.973ESRDHCC 9 — Lung and Other Severe Cancers
0.000RxHCCHCC 20 — Cancer, Liver and Intrahepatic Bile Duct
0.000What This Code Means
Cancer that develops in the pleura, which is the thin membrane that lines the lungs and chest wall.
Coding Tips
- •Pleural mesothelioma is the most common pleural malignancy; document if mesothelioma is present
- •Distinguish from lung cancer that has spread to the pleura (metastatic disease)
Clinical Significance
Pleural malignancies include mesothelioma (strongly linked to asbestos exposure) and other primary pleural cancers. Malignant mesothelioma is the most important diagnosis in this category, carrying a very poor prognosis with median survival under 18 months. This code maps to the highest cancer severity tier for risk adjustment, reflecting the intensive care these patients require.
Documentation Requirements
- ✓Pathology confirming primary pleural malignancy (biopsy required — cytology alone is often insufficient)
- ✓Histological type: epithelioid, sarcomatoid, or biphasic mesothelioma
- ✓Asbestos exposure history
- ✓Imaging documenting pleural thickening, nodularity, or mass
- ✓Confirmation that this is primary pleural cancer, not secondary involvement from lung cancer
Commonly Confused Codes
C45.0 — Mesothelioma of pleura: More specific code for confirmed mesothelioma; use C45.0 when mesothelioma is confirmedC78.2 — Secondary malignant neoplasm of pleura: Metastatic pleural disease from lung, breast, or other cancersJ91.0 — Malignant pleural effusion: Effusion code; use additionally with the neoplasm codeC34.xx — Lung cancer codes: Lung cancer invading the pleura should be coded at the lung primary site