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ICD-10 Guide
ICD-10 CodesC10.2

C10.2

Billable

Malignant neoplasm of lateral wall of oropharynx

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

Code Description

ICD-10 C10.2 is a billable code used to indicate a diagnosis of malignant neoplasm of lateral wall of oropharynx.

Key Diagnostic Point:

C10.2 refers to a malignant neoplasm located specifically in the lateral wall of the oropharynx, which is a part of the throat situated behind the mouth. This area includes the tonsils, the base of the tongue, and the soft palate. Oropharyngeal cancers, including those classified under C10.2, are often associated with risk factors such as tobacco use, alcohol consumption, and human papillomavirus (HPV) infection. HPV-positive oropharyngeal cancers have been on the rise, particularly among younger populations, and are known to have a better prognosis compared to HPV-negative cases. Treatment typically involves a combination of surgery, radiation therapy, and chemotherapy, depending on the stage and location of the tumor. Radiation therapy is a common treatment modality, especially for localized tumors, and can be delivered as external beam radiation or brachytherapy. Accurate coding for C10.2 requires careful documentation of the tumor's location, size, and any associated HPV status, as these factors significantly influence treatment decisions and outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for precise anatomical localization of the tumor
  • Differentiation between HPV-positive and HPV-negative cases
  • Variability in treatment approaches based on tumor staging
  • Documentation of associated symptoms and comorbidities

Audit Risk Factors

  • Inadequate documentation of tumor location
  • Failure to specify HPV status
  • Incorrect staging of the cancer
  • Omission of treatment details

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Diagnosis and treatment planning for oropharyngeal cancers, follow-up care.

Billing Considerations

Ensure accurate staging and documentation of HPV status for treatment planning.

Otolaryngology

Documentation Requirements

Surgical notes, biopsy results, and pre-operative assessments.

Common Clinical Scenarios

Surgical intervention for tumor resection, management of complications.

Billing Considerations

Document anatomical details and surgical margins to support coding.

Coding Guidelines

Inclusion Criteria

Use C10.2 When
  • According to ICD
  • 10 coding guidelines, C10
  • 2 should be used when the documentation specifies a malignant neoplasm located in the lateral wall of the oropharynx
  • Coders must ensure that the diagnosis is confirmed by pathology and that any relevant staging information is included

Exclusion Criteria

Do NOT use C10.2 When
  • Exclusions include benign neoplasms and neoplasms of other parts of the pharynx

Related ICD-10 Codes

Related CPT Codes

21550CPT Code

Excision, malignant tumor, head and neck

Clinical Scenario

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

Documentation Requirements

Surgical notes detailing the procedure and margins.

Specialty Considerations

Otolaryngology specialists should ensure complete documentation of the surgical approach.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of oropharyngeal cancers, improving the accuracy of data collection and treatment planning. C10.2 provides a clear distinction for malignant neoplasms in the lateral wall, which aids in research and epidemiological studies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of oropharyngeal cancers, improving the accuracy of data collection and treatment planning. C10.2 provides a clear distinction for malignant neoplasms in the lateral wall, which aids in research and epidemiological studies.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of oropharyngeal cancers, improving the accuracy of data collection and treatment planning. C10.2 provides a clear distinction for malignant neoplasms in the lateral wall, which aids in research and epidemiological studies.

Resources

Clinical References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery

Coding & Billing References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery

Frequently Asked Questions

What is the significance of HPV status in coding C10.2?

HPV status is crucial as it influences treatment options and prognosis. Accurate documentation of HPV status is necessary for proper coding and to reflect the patient's clinical picture.