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v1.0.0
ICD-10 Guide
ICD-10 CodesChapter 2: NeoplasmsC11

C11

Billable

Malignant neoplasm of nasopharynx

Chapter 2:Neoplasms

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

Code Description

ICD-10 C11 is a billable code used to indicate a diagnosis of malignant neoplasm of nasopharynx.

Key Diagnostic Point:

Malignant neoplasm of the nasopharynx, classified under ICD-10 code C11, refers to cancerous growths that originate in the nasopharynx, the upper part of the throat behind the nose. This type of cancer is often associated with the Epstein-Barr virus (EBV) and is more prevalent in certain geographic regions, particularly Southeast Asia. Symptoms may include nasal obstruction, ear fullness, hearing loss, and neck masses due to lymph node involvement. Diagnosis typically involves imaging studies such as MRI or CT scans, along with biopsy for histological confirmation. Treatment options often include radiation therapy, chemotherapy, or a combination of both, depending on the stage and extent of the disease. The prognosis varies significantly based on the stage at diagnosis and the patient's overall health. Understanding the HPV status is crucial, as certain strains of HPV are linked to oropharyngeal cancers, which can influence treatment decisions and prognostic outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in staging and grading of the tumor
  • Need for precise documentation of HPV status
  • Differentiation from other head and neck cancers
  • Complex treatment regimens involving radiation and chemotherapy

Audit Risk Factors

  • Inadequate documentation of HPV status
  • Failure to document staging and grading
  • Misclassification of tumor site
  • Lack of clarity in treatment plans

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed treatment plans, staging information, and pathology reports are essential.

Common Clinical Scenarios

Patients presenting with neck masses, nasal obstruction, or ear symptoms.

Billing Considerations

Ensure accurate coding of treatment modalities and follow-up care.

Radiation Oncology

Documentation Requirements

Radiation treatment plans, dosimetry reports, and follow-up imaging results.

Common Clinical Scenarios

Patients receiving radiation therapy for nasopharyngeal cancer.

Billing Considerations

Document the specific radiation techniques used and any side effects experienced.

Coding Guidelines

Inclusion Criteria

Use C11 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the primary site, histology, and any associated conditions
  • Include details on the patient's HPV status and treatment history

Exclusion Criteria

Do NOT use C11 When
No specific exclusions found.

Related CPT Codes

77401CPT Code

Radiation treatment delivery

Clinical Scenario

Used for patients receiving radiation therapy for nasopharyngeal cancer.

Documentation Requirements

Radiation treatment plans and patient consent forms.

Specialty Considerations

Oncology specialists should ensure accurate coding of treatment modalities.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of nasopharyngeal cancers, improving the accuracy of data collection and reimbursement processes. It has also facilitated better tracking of treatment outcomes and epidemiological studies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of nasopharyngeal cancers, improving the accuracy of data collection and reimbursement processes. It has also facilitated better tracking of treatment outcomes and epidemiological studies.

Reimbursement & Billing Impact

reimbursement processes. It has also facilitated better tracking of treatment outcomes and epidemiological studies.

Resources

Clinical References

  • •
    American Cancer Society - Nasopharyngeal Cancer

Coding & Billing References

  • •
    American Cancer Society - Nasopharyngeal Cancer

Frequently Asked Questions

What is the significance of HPV status in nasopharyngeal cancer?

HPV status can influence treatment decisions and prognostic outcomes. HPV-positive tumors may respond differently to treatment compared to HPV-negative tumors.