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ICD-10 Guide
ICD-10 CodesC04.9

C04.9

Billable

Malignant neoplasm of floor of mouth, unspecified

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

Code Description

ICD-10 C04.9 is a billable code used to indicate a diagnosis of malignant neoplasm of floor of mouth, unspecified.

Key Diagnostic Point:

Malignant neoplasms of the floor of the mouth are cancers that arise from the tissues in this area, which includes the sublingual glands, muscles, and mucosal lining. These tumors can present as asymptomatic lesions or may cause symptoms such as pain, difficulty swallowing, or changes in speech. The floor of the mouth is a critical area for oral function, and malignancies here can significantly impact a patient's quality of life. Risk factors include tobacco use, alcohol consumption, and HPV infection. Diagnosis typically involves a thorough clinical examination, imaging studies, and biopsy to confirm malignancy. Treatment often requires a multidisciplinary approach, including surgical intervention, radiation therapy, and chemotherapy, depending on the stage and type of cancer. Early detection is crucial for improving outcomes, and regular dental check-ups can aid in identifying suspicious lesions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and symptoms of oral cavity cancers
  • Need for comprehensive documentation of staging and treatment plans
  • Potential for overlapping symptoms with benign conditions
  • Multidisciplinary care involvement requiring coordination of documentation

Audit Risk Factors

  • Inadequate documentation of tumor staging
  • Failure to document multidisciplinary treatment approaches
  • Misclassification of benign lesions as malignant
  • Lack of follow-up documentation post-treatment

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed treatment plans, staging information, and follow-up care notes are essential.

Common Clinical Scenarios

Patients presenting with lesions on the floor of the mouth requiring biopsy and subsequent treatment.

Billing Considerations

Ensure accurate documentation of tumor characteristics and treatment responses.

Dentistry

Documentation Requirements

Comprehensive oral examinations and documentation of any suspicious lesions.

Common Clinical Scenarios

Routine dental exams revealing lesions that require referral to oncology.

Billing Considerations

Collaboration with oncologists for accurate coding and treatment documentation.

Coding Guidelines

Inclusion Criteria

Use C04.9 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the specific site of the malignancy is not documented
  • Include additional codes for any associated conditions or complications

Exclusion Criteria

Do NOT use C04.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

40800CPT Code

Biopsy of oral cavity

Clinical Scenario

Used when a lesion on the floor of the mouth is biopsied to confirm malignancy.

Documentation Requirements

Document the reason for biopsy, findings, and any complications.

Specialty Considerations

Oncologists and dentists should coordinate to ensure accurate coding.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of oral cavity malignancies, improving the accuracy of data collection and reimbursement processes. C04.9 provides a clear classification for unspecified malignant neoplasms, facilitating better tracking of treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of oral cavity malignancies, improving the accuracy of data collection and reimbursement processes. C04.9 provides a clear classification for unspecified malignant neoplasms, facilitating better tracking of treatment outcomes.

Reimbursement & Billing Impact

reimbursement processes. C04.9 provides a clear classification for unspecified malignant neoplasms, facilitating better tracking of treatment outcomes.

Resources

Clinical References

  • •
    American Cancer Society - Oral Cavity and Oropharyngeal Cancers

Coding & Billing References

  • •
    American Cancer Society - Oral Cavity and Oropharyngeal Cancers

Frequently Asked Questions

What is the significance of coding C04.9?

C04.9 is significant as it allows for the classification of unspecified malignant neoplasms of the floor of the mouth, which is crucial for treatment planning and tracking patient outcomes.