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ICD-10 Guide
ICD-10 CodesC11.2

C11.2

Billable

Malignant neoplasm of lateral wall of nasopharynx

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

Code Description

ICD-10 C11.2 is a billable code used to indicate a diagnosis of malignant neoplasm of lateral wall of nasopharynx.

Key Diagnostic Point:

C11.2 refers to a malignant neoplasm located specifically in the lateral 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 Epstein-Barr virus (EBV) infection and, in some cases, human papillomavirus (HPV). The lateral wall of the nasopharynx includes structures such as the Eustachian tube orifice and the adenoids, which can be involved in the tumor's growth. Symptoms may include nasal obstruction, ear fullness, and otitis media due to Eustachian tube dysfunction. Diagnosis typically involves imaging studies and biopsy. Treatment often includes radiation therapy, which is a standard approach for localized nasopharyngeal cancers, and may be combined with chemotherapy. The prognosis can vary based on the stage at diagnosis and the tumor's HPV status, with HPV-positive tumors generally having a better prognosis. Accurate coding is essential for appropriate treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in tumor staging and classification
  • Need for precise anatomical localization
  • Differentiation between HPV-positive and HPV-negative tumors
  • Documentation of treatment modalities (e.g., radiation therapy)

Audit Risk Factors

  • Inadequate documentation of tumor staging
  • Failure to specify HPV status
  • Misclassification of tumor location
  • Lack of treatment documentation (e.g., radiation therapy details)

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans must be documented.

Common Clinical Scenarios

Diagnosis and treatment planning for nasopharyngeal cancer, follow-up care post-radiation therapy.

Billing Considerations

Ensure accurate staging and HPV status documentation for treatment planning.

Otolaryngology

Documentation Requirements

Comprehensive examination findings, imaging results, and surgical notes if applicable.

Common Clinical Scenarios

Evaluation of nasal obstruction, ear fullness, and biopsy procedures.

Billing Considerations

Document anatomical details and any surgical interventions performed.

Coding Guidelines

Inclusion Criteria

Use C11.2 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the tumor's location, staging, and any associated conditions
  • Include details on HPV status when relevant

Exclusion Criteria

Do NOT use C11.2 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

77263CPT Code

Radiation treatment delivery, 3D conformal technique

Clinical Scenario

Used in conjunction with C11.2 for treatment planning and delivery.

Documentation Requirements

Radiation treatment plans and delivery notes must be documented.

Specialty Considerations

Oncology must 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. C11.2 provides a clear distinction for lateral wall tumors, which aids in treatment planning 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. C11.2 provides a clear distinction for lateral wall tumors, which aids in treatment planning and epidemiological studies.

Reimbursement & Billing Impact

reimbursement processes. C11.2 provides a clear distinction for lateral wall tumors, which aids in treatment planning 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 is significant as it can influence treatment decisions and prognosis. HPV-positive tumors generally have a better response to treatment and a more favorable prognosis compared to HPV-negative tumors.