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ICD-10 Guide
ICD-10 CodesC11.1

C11.1

Billable

Malignant neoplasm of posterior wall of nasopharynx

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

Code Description

ICD-10 C11.1 is a billable code used to indicate a diagnosis of malignant neoplasm of posterior wall of nasopharynx.

Key Diagnostic Point:

C11.1 refers to a malignant neoplasm located specifically in the posterior wall of the nasopharynx, which is the upper part of the throat behind the nose. This area is a common site for oropharyngeal and nasopharyngeal cancers, often associated with risk factors such as tobacco use, alcohol consumption, and notably, human papillomavirus (HPV) infection. HPV-positive oropharyngeal cancers have been on the rise, particularly among younger populations, and are often characterized by better prognosis compared to HPV-negative cases. The clinical presentation may include symptoms such as nasal obstruction, epistaxis, hearing loss, and neck masses due to lymphadenopathy. Diagnosis typically involves imaging studies and biopsy. Treatment often includes radiation therapy, which can be curative, especially in early-stage cancers, but may also lead to significant side effects that require careful management. Understanding the nuances of this diagnosis is crucial for accurate coding and appropriate treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation between HPV-positive and HPV-negative cases
  • Need for precise anatomical localization
  • Variability in treatment approaches (surgery, radiation, chemotherapy)
  • Potential for metastasis and staging considerations

Audit Risk Factors

  • Inadequate documentation of HPV status
  • Failure to specify the exact location of the neoplasm
  • Misclassification of benign versus malignant lesions
  • Lack of supporting imaging or pathology reports

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed clinical notes including symptoms, imaging results, and biopsy findings.

Common Clinical Scenarios

Patients presenting with neck masses, nasal obstruction, or unexplained epistaxis.

Billing Considerations

Ensure clear documentation of the tumor's location and HPV status for accurate coding.

Oncology

Documentation Requirements

Comprehensive treatment plans, including chemotherapy and radiation therapy details.

Common Clinical Scenarios

Management of patients undergoing radiation therapy or chemotherapy for nasopharyngeal cancer.

Billing Considerations

Document treatment response and any side effects experienced by the patient.

Coding Guidelines

Inclusion Criteria

Use C11.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the diagnosis, including the specific site and HPV status
  • Include any relevant staging information as per the AJCC Cancer Staging Manual

Exclusion Criteria

Do NOT use C11.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

70450CPT Code

CT scan of the head or neck

Clinical Scenario

Used for initial evaluation of suspected nasopharyngeal cancer.

Documentation Requirements

Indicate the reason for the scan and any relevant clinical findings.

Specialty Considerations

Otolaryngologists often order imaging to assess tumor size and location.

30140CPT Code

Biopsy of nasopharynx

Clinical Scenario

Performed to confirm diagnosis of malignant neoplasm.

Documentation Requirements

Document the technique used and findings.

Specialty Considerations

Oncologists may perform biopsies to determine treatment plans.

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 data accuracy and facilitating better tracking of treatment outcomes and epidemiological trends.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of nasopharyngeal cancers, improving data accuracy and facilitating better tracking of treatment outcomes and epidemiological trends.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of nasopharyngeal cancers, improving data accuracy and facilitating better tracking of treatment outcomes and epidemiological trends.

Resources

Clinical References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery
  • •
    National Cancer Institute - Nasopharyngeal Cancer

Coding & Billing References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery
  • •
    National Cancer Institute - Nasopharyngeal Cancer

Frequently Asked Questions

What is the significance of HPV status in nasopharyngeal cancer?

HPV status is crucial as it influences treatment decisions and prognosis. HPV-positive tumors generally have a better response to treatment and a more favorable prognosis compared to HPV-negative tumors.

How should I document a patient's treatment for C11.1?

Document all relevant clinical findings, treatment plans, and responses to therapy. Include details about any radiation therapy, chemotherapy, or surgical interventions.