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v1.0.0
ICD-10 Guide
ICD-10 CodesChapter 2: NeoplasmsC13

C13

Billable

Malignant neoplasm of hypopharynx

Chapter 2:Neoplasms

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

Code Description

ICD-10 C13 is a billable code used to indicate a diagnosis of malignant neoplasm of hypopharynx.

Key Diagnostic Point:

Malignant neoplasm of the hypopharynx refers to cancerous growths located in the hypopharynx, which is the lower part of the pharynx situated behind the larynx. This type of cancer can arise from squamous cells and is often associated with risk factors such as tobacco use, alcohol consumption, and human papillomavirus (HPV) infection. The hypopharynx connects the oropharynx and the esophagus, making it a critical area for swallowing and speech. Symptoms may include difficulty swallowing, hoarseness, sore throat, and unexplained weight loss. Diagnosis typically involves imaging studies, endoscopy, and biopsy. Treatment options may include surgery, radiation therapy, and chemotherapy, with radiation therapy being a common approach for localized tumors. The prognosis depends on the stage at diagnosis and the presence of HPV, which has been linked to a better response to treatment in some cases. Accurate coding requires careful documentation of the tumor's location, size, and any associated HPV status, as these factors can influence treatment decisions and outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between hypopharyngeal and oropharyngeal cancers
  • HPV status documentation and its implications for treatment
  • Variability in treatment approaches (surgery vs. radiation therapy)
  • Need for precise staging information

Audit Risk Factors

  • Inadequate documentation of HPV status
  • Failure to specify the exact site of the neoplasm
  • Misclassification of tumor stage
  • Omission of treatment details (e.g., radiation therapy)

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with dysphagia, hoarseness, or neck masses.

Billing Considerations

Ensure accurate staging and HPV status are documented to guide treatment.

Radiation Oncology

Documentation Requirements

Radiation treatment plans, dosimetry, and follow-up assessments are essential.

Common Clinical Scenarios

Patients receiving radiation therapy for localized hypopharyngeal tumors.

Billing Considerations

Document the specific radiation technique and dosage for accurate coding.

Coding Guidelines

Inclusion Criteria

Use C13 When
  • According to ICD
  • 10 coding guidelines, C13 should be used when the diagnosis of malignant neoplasm of the hypopharynx is confirmed
  • Coders must ensure that the documentation supports the diagnosis, including the site, histology, and any relevant staging information
  • malignant conditions affecting the hypopharynx

Exclusion Criteria

Do NOT use C13 When
  • Exclusion criteria include benign neoplasms and non

Related CPT Codes

31575CPT Code

Laryngoscopy, flexible, diagnostic

Clinical Scenario

Used for initial evaluation of suspected hypopharyngeal cancer.

Documentation Requirements

Document findings from the laryngoscopy and any biopsies taken.

Specialty Considerations

Ensure that the procedure is linked to the diagnosis of C13.

77401CPT Code

Radiation treatment delivery

Clinical Scenario

Used for patients undergoing radiation therapy for hypopharyngeal cancer.

Documentation Requirements

Document the treatment plan and any modifications made during therapy.

Specialty Considerations

Link the radiation treatment to the specific diagnosis of C13.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of hypopharyngeal cancers, improving the accuracy of data collection and reimbursement processes. The detailed coding structure helps in 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 hypopharyngeal cancers, improving the accuracy of data collection and reimbursement processes. The detailed coding structure helps in better tracking of treatment outcomes and epidemiological studies.

Reimbursement & Billing Impact

reimbursement processes. The detailed coding structure helps in better tracking of treatment outcomes and epidemiological studies.

Resources

Clinical References

  • •
    American Cancer Society - Hypopharyngeal Cancer

Coding & Billing References

  • •
    American Cancer Society - Hypopharyngeal Cancer

Frequently Asked Questions

What is the significance of HPV status in coding C13?

HPV status can influence treatment decisions and prognosis. Accurate documentation of HPV status is essential for coding and may affect the reimbursement process.

How do I differentiate between hypopharyngeal and oropharyngeal cancers?

Hypopharyngeal cancer is located below the oropharynx and may present with different symptoms and treatment approaches. Accurate documentation of the tumor's location is crucial for correct coding.