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v1.0.0
ICD-10 Guide
ICD-10 CodesC13.1

C13.1

Billable

Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect

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

Code Description

ICD-10 C13.1 is a billable code used to indicate a diagnosis of malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect.

Key Diagnostic Point:

C13.1 refers to a malignant neoplasm located specifically in the aryepiglottic fold on the hypopharyngeal aspect. This area is critical for both airway protection and phonation. Malignant tumors in this region can arise from squamous cells and are often associated with risk factors such as tobacco use and HPV infection. The hypopharynx is a common site for oropharyngeal cancers, which can present with symptoms such as dysphagia, odynophagia, and changes in voice. HPV status is particularly relevant, as HPV-positive oropharyngeal cancers tend to have a better prognosis compared to HPV-negative cases. Treatment typically involves a multidisciplinary approach, including surgery, radiation therapy, and chemotherapy, depending on the stage and location of the tumor. Radiation therapy is often employed to target the neoplasm while preserving surrounding healthy tissue, but it can also lead to complications such as mucositis and xerostomia. Accurate coding for C13.1 is essential for appropriate treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation between malignant and benign neoplasms
  • Need for precise anatomical localization
  • Variability in treatment protocols based on HPV status
  • Potential for multiple primary tumors in head and neck cancers

Audit Risk Factors

  • Inadequate documentation of tumor location
  • Failure to document HPV status
  • Misclassification of tumor type (malignant vs. benign)
  • Incomplete staging information

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed descriptions of tumor location, size, and staging; HPV status; treatment plans.

Common Clinical Scenarios

Diagnosis and management of hypopharyngeal cancers, surgical interventions, and follow-up care.

Billing Considerations

Ensure clear documentation of the multidisciplinary approach to treatment, including referrals to oncology and radiation therapy.

Oncology

Documentation Requirements

Comprehensive treatment plans, including chemotherapy and radiation therapy details, and follow-up assessments.

Common Clinical Scenarios

Management of patients with HPV-positive or negative oropharyngeal cancers, including palliative care considerations.

Billing Considerations

Document the rationale for treatment choices based on tumor characteristics and patient health status.

Coding Guidelines

Inclusion Criteria

Use C13.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the site, type, and stage of the neoplasm
  • Include any relevant modifiers for treatment
  • related complications

Exclusion Criteria

Do NOT use C13.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

31575CPT Code

Laryngoscopy, flexible, diagnostic

Clinical Scenario

Used for initial evaluation of suspected hypopharyngeal malignancy.

Documentation Requirements

Document findings from the laryngoscopy and any biopsies taken.

Specialty Considerations

Otolaryngologists should ensure thorough documentation of the procedure and findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of malignant neoplasms, improving the accuracy of data collection and reimbursement processes. C13.1 provides a clear distinction for hypopharyngeal cancers, 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 malignant neoplasms, improving the accuracy of data collection and reimbursement processes. C13.1 provides a clear distinction for hypopharyngeal cancers, which aids in treatment planning and epidemiological studies.

Reimbursement & Billing Impact

reimbursement processes. C13.1 provides a clear distinction for hypopharyngeal cancers, which aids in treatment planning and epidemiological studies.

Resources

Clinical References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery

Coding & Billing References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery

Frequently Asked Questions

What is the significance of HPV status in coding C13.1?

HPV status is crucial as it influences treatment decisions and prognosis. Accurate documentation of HPV status is necessary for coding and can affect reimbursement and treatment planning.