D38.5 ICD-10-CM Code: Neoplasm of uncertain behavior of other respiratory organs
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FY 2026 Apr update / Neoplasms (C00-D49) / Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48)
D38.5
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNeoplasm of uncertain behavior of other respiratory organs
A growth in other parts of the respiratory system (not larynx, trachea, bronchus, lung, pleura, mediastinum, or thymus) that cannot yet be determined to be cancer or benign.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Neoplasm of uncertain behavior of accessory sinuses
- Neoplasm of uncertain behavior of cartilage of nose
- Neoplasm of uncertain behavior of middle ear
- Neoplasm of uncertain behavior of nasal cavities
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for D38.5 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for D38.5 in this effective period.
Excludes 1
Official- neoplasm of uncertain behavior of ear (external) (skin) (D48.5)
- neoplasm of uncertain behavior of nose NOS (D48.7)
- neoplasm of uncertain behavior of skin of nose (D48.5)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for D38.5 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for D38.5 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for D38.5 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is D38.5 an HCC code?
No. D38.5 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
D38.5 is the ICD-10-CM diagnosis code for neoplasm of uncertain behavior of other respiratory organs. A growth in other parts of the respiratory system (not larynx, trachea, bronchus, lung, pleura, mediastinum, or thymus) that cannot yet be determined to be cancer or benign. D38.5 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (d37-d48).
D38.5 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code covers less common respiratory sites such as the diaphragm or other thoracic structures.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D38.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code covers less common respiratory sites such as the diaphragm or other thoracic structures
- •Always document the specific respiratory organ involved to support accurate coding