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ICD-10 Guide
ICD-10 CodesC11.9

C11.9

Billable

Malignant neoplasm of nasopharynx, unspecified

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

Code Description

ICD-10 C11.9 is a billable code used to indicate a diagnosis of malignant neoplasm of nasopharynx, unspecified.

Key Diagnostic Point:

C11.9 refers to a malignant neoplasm located in the nasopharynx, which is the upper part of the throat behind the nose. This type of cancer is often associated with specific risk factors, including Epstein-Barr virus (EBV) infection and, in some cases, human papillomavirus (HPV). The nasopharynx is a critical area for the respiratory and digestive systems, and malignancies here can lead to significant complications, including obstruction of airflow and swallowing difficulties. Symptoms may include nasal obstruction, ear fullness, 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 often includes radiation therapy, which is a primary modality for nasopharyngeal carcinoma, especially in localized cases. The prognosis can vary significantly based on the stage at diagnosis and the presence of HPV, which has been linked to a better response to treatment in oropharyngeal cancers. Accurate coding is essential for appropriate treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified nature of the neoplasm complicates treatment planning.
  • Differentiation between nasopharyngeal and oropharyngeal cancers is critical.
  • HPV status can influence treatment and prognosis.
  • Radiation therapy documentation must be precise to support coding.

Audit Risk Factors

  • Inadequate documentation of HPV status.
  • Lack of detailed imaging reports.
  • Insufficient biopsy results or pathology reports.
  • Failure to document treatment plans, especially radiation therapy.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Comprehensive documentation of diagnosis, staging, and treatment plans.

Common Clinical Scenarios

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

Billing Considerations

Documentation must include HPV status and treatment response.

Radiation Oncology

Documentation Requirements

Detailed treatment plans, including radiation dosage and technique.

Common Clinical Scenarios

Patients undergoing radiation therapy for nasopharyngeal carcinoma.

Billing Considerations

Accurate coding of radiation therapy procedures is essential.

Coding Guidelines

Inclusion Criteria

Use C11.9 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the diagnosis is confirmed
  • Include documentation of the site, histology, and any relevant staging information

Exclusion Criteria

Do NOT use C11.9 When
  • Exclude codes for benign neoplasms or other specified conditions

Related ICD-10 Codes

Related CPT Codes

77401CPT Code

Radiation treatment delivery, external beam, per treatment session

Clinical Scenario

Used for patients receiving radiation therapy for nasopharyngeal carcinoma.

Documentation Requirements

Detailed treatment plan and session notes.

Specialty Considerations

Oncology must document the rationale for radiation therapy.

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. C11.9 serves as a catch-all for unspecified cases, but coders should strive for specificity when possible.

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. C11.9 serves as a catch-all for unspecified cases, but coders should strive for specificity when possible.

Reimbursement & Billing Impact

reimbursement processes. C11.9 serves as a catch-all for unspecified cases, but coders should strive for specificity when possible.

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 prognosis. HPV-positive oropharyngeal cancers tend to have a better response to treatment compared to HPV-negative cases.