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ICD-10 Guide
ICD-10 CodesC04.8

C04.8

Billable

Malignant neoplasm of overlapping sites of floor of mouth

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 C04.8 is a billable code used to indicate a diagnosis of malignant neoplasm of overlapping sites of floor of mouth.

Key Diagnostic Point:

C04.8 refers to malignant neoplasms that occur in overlapping sites of the floor of the mouth, which is a complex anatomical region that includes various structures such as the sublingual glands, the mylohyoid muscle, and the lingual frenulum. These tumors can arise from squamous cells, salivary glands, or other tissues in the area. The clinical presentation may include swelling, pain, difficulty swallowing, or changes in speech. Diagnosis typically involves a combination of clinical examination, imaging studies, and biopsy. Treatment often requires a multidisciplinary approach, including surgical intervention, radiation therapy, and chemotherapy, depending on the stage and type of cancer. Dental considerations are crucial, as oral health can significantly impact treatment outcomes and quality of life. Regular dental evaluations and interventions may be necessary to manage complications such as infections or oral mucositis during cancer treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Overlap of anatomical sites complicates precise coding.
  • Variability in tumor types and treatment approaches.
  • Need for detailed documentation of clinical findings.
  • Potential for multiple concurrent diagnoses in the oral cavity.

Audit Risk Factors

  • Inadequate documentation of tumor location and type.
  • Failure to capture all relevant diagnoses.
  • Misinterpretation of overlapping site definitions.
  • Lack of interdisciplinary notes in the medical record.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans are essential for accurate coding.

Common Clinical Scenarios

Patients presenting with symptoms such as oral lesions, dysphagia, or unexplained weight loss.

Billing Considerations

Ensure all treatment modalities are documented, including surgery, chemotherapy, and radiation therapy.

Dentistry

Documentation Requirements

Comprehensive dental evaluations and treatment notes, especially regarding oral hygiene and management of complications.

Common Clinical Scenarios

Patients undergoing treatment for oral cancers requiring dental interventions.

Billing Considerations

Coordination with oncology for managing oral side effects of cancer treatments.

Coding Guidelines

Inclusion Criteria

Use C04.8 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the site and type of malignancy
  • Include any relevant staging information and treatment details to support the diagnosis

Exclusion Criteria

Do NOT use C04.8 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

40800CPT Code

Excision of lesion of floor of mouth

Clinical Scenario

Used when a malignant lesion is surgically removed.

Documentation Requirements

Operative notes detailing the procedure and findings.

Specialty Considerations

Oncologists and oral surgeons must coordinate documentation.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of oral malignancies, improving data accuracy and facilitating better patient management through detailed documentation of tumor characteristics and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of oral malignancies, improving data accuracy and facilitating better patient management through detailed documentation of tumor characteristics and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of oral malignancies, improving data accuracy and facilitating better patient management through detailed documentation of tumor characteristics and treatment outcomes.

Resources

Clinical References

  • •
    American Cancer Society - Oral Cavity and Oropharyngeal Cancer

Coding & Billing References

  • •
    American Cancer Society - Oral Cavity and Oropharyngeal Cancer

Frequently Asked Questions

What are the common symptoms of malignant neoplasms in the floor of the mouth?

Common symptoms include pain, swelling, difficulty swallowing, and changes in speech. Patients may also experience non-healing ulcers or lesions.