Question 1

What is ICD-10 code D48.3?

Accepted Answer

D48.3 is the ICD-10-CM diagnosis code for neoplasm of uncertain behavior of retroperitoneum. A growth in the retroperitoneum (the space behind the abdominal cavity) that is not clearly cancer but has uncertain behavior. D48.3 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).

D48.3 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.

Retroperitoneal tumors are often discovered incidentally on imaging; ensure the uncertain behavior is confirmed by pathology.

Question 2

Is D48.3 an HCC code?

Accepted Answer

No. D48.3 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is D48.3 billable?

Accepted Answer

Yes. D48.3 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. D48.3 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for D48.3?

Accepted Answer

D48.3 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards D48.3 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting D48.3?

Accepted Answer

Retroperitoneal tumors are often discovered incidentally on imaging; ensure the uncertain behavior is confirmed by pathology Document the specific location within the retroperitoneum if possible for clinical clarity

HCC Buddy Code Card

D48.3

Is D48.3 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work D48.3 in HCC Buddy

D48.3 ICD-10-CM Code: Neoplasm of uncertain behavior of retroperitoneum

HCC Buddy Code Card

D48.3

Is D48.3 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work D48.3 in HCC Buddy