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v1.0.0
ICD-10 Guide
ICD-10 CodesC05.1

C05.1

Billable

Malignant neoplasm of soft palate

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

Code Description

ICD-10 C05.1 is a billable code used to indicate a diagnosis of malignant neoplasm of soft palate.

Key Diagnostic Point:

Malignant neoplasm of the soft palate is a type of cancer that originates in the soft tissue of the palate, which is the back part of the roof of the mouth. This condition is classified under oral cavity malignancies and is often associated with risk factors such as tobacco use, alcohol consumption, and human papillomavirus (HPV) infection. Symptoms may include difficulty swallowing, persistent sore throat, changes in voice, and the presence of a lump or sore that does not heal. Diagnosis typically involves a thorough clinical examination, imaging studies, and biopsy to confirm malignancy. Treatment options may include surgery, radiation therapy, and chemotherapy, often requiring a multidisciplinary approach involving oncologists, surgeons, and dental specialists to manage the complexities of oral cavity cancers effectively. Early detection and intervention are crucial for improving patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and symptoms among patients
  • Need for comprehensive documentation of staging and treatment
  • Potential for co-existing oral conditions complicating diagnosis
  • Multidisciplinary care requirements involving multiple specialties

Audit Risk Factors

  • Inadequate documentation of staging and treatment plans
  • Failure to capture co-morbid conditions affecting treatment
  • Misclassification of tumor type or location
  • Lack of follow-up documentation post-treatment

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed treatment plans, staging information, and follow-up care documentation.

Common Clinical Scenarios

Management of newly diagnosed patients, treatment planning, and post-treatment surveillance.

Billing Considerations

Ensure accurate staging and documentation of treatment response.

Dentistry

Documentation Requirements

Comprehensive oral examinations, imaging studies, and treatment notes.

Common Clinical Scenarios

Assessment of oral lesions, coordination of care with oncologists, and management of oral complications.

Billing Considerations

Document any dental interventions related to cancer treatment, such as extractions or prosthetics.

Coding Guidelines

Inclusion Criteria

Use C05.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the diagnosis, staging, and treatment
  • Include any relevant co
  • morbidities and complications that may affect patient management

Exclusion Criteria

Do NOT use C05.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

42800CPT Code

Excision of malignant lesion of the palate

Clinical Scenario

Used when a patient undergoes surgical excision of a malignant neoplasm of the soft palate.

Documentation Requirements

Document the size, location, and type of lesion excised.

Specialty Considerations

Ensure coordination with oncology for comprehensive care.

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.

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.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American Cancer Society - Oral Cavity Cancer

Coding & Billing References

  • •
    American Cancer Society - Oral Cavity Cancer

Frequently Asked Questions

What are the common symptoms of malignant neoplasm of the soft palate?

Common symptoms include difficulty swallowing, persistent sore throat, changes in voice, and the presence of a lump or sore that does not heal.

How is a malignant neoplasm of the soft palate diagnosed?

Diagnosis typically involves a clinical examination, imaging studies, and biopsy to confirm malignancy.