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v1.0.0
ICD-10 Guide
ICD-10 CodesChapter 2: NeoplasmsC14

C14

Billable

Malignant neoplasm of other and ill-defined sites in the lip, oral cavity and pharynx

Chapter 2:Neoplasms

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

Code Description

ICD-10 C14 is a billable code used to indicate a diagnosis of malignant neoplasm of other and ill-defined sites in the lip, oral cavity and pharynx.

Key Diagnostic Point:

C14 encompasses malignant neoplasms located in the lip, oral cavity, and pharynx that do not fit into more specific categories. This includes cancers of the oropharynx and nasopharynx, which are often associated with human papillomavirus (HPV) infection. Oropharyngeal cancers typically arise in the tonsils, base of the tongue, and soft palate, while nasopharyngeal cancers originate in the upper part of the throat behind the nose. HPV-positive oropharyngeal cancers have distinct epidemiological and clinical characteristics, often presenting in younger patients with a better prognosis compared to HPV-negative cases. Treatment may involve radiation therapy, chemotherapy, or surgical intervention, depending on the stage and location of the tumor. Accurate coding requires careful documentation of the tumor site, HPV status, and treatment modalities, as these factors significantly influence management and outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in tumor location and type within the pharynx
  • Need for accurate HPV status documentation
  • Differentiation between oropharyngeal and nasopharyngeal cancers
  • Potential for overlapping symptoms with benign conditions

Audit Risk Factors

  • Inadequate documentation of HPV status
  • Failure to specify the exact site of the neoplasm
  • Misclassification of tumor type or stage
  • Incomplete treatment documentation

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, treatment plans, and follow-up notes are essential.

Common Clinical Scenarios

Diagnosis and management of oropharyngeal and nasopharyngeal cancers, including staging and treatment response.

Billing Considerations

Documentation must clearly indicate the tumor site, HPV status, and treatment modalities to ensure accurate coding.

Radiation Oncology

Documentation Requirements

Radiation treatment plans, dosimetry reports, and patient consent forms are necessary.

Common Clinical Scenarios

Patients receiving radiation therapy for oropharyngeal or nasopharyngeal cancers.

Billing Considerations

Accurate coding requires documentation of the specific radiation technique and treatment course.

Coding Guidelines

Inclusion Criteria

Use C14 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the site of the neoplasm is accurately documented
  • Include any relevant details about HPV status and treatment modalities
  • Codes should be assigned based on the most specific site available

Exclusion Criteria

Do NOT use C14 When
No specific exclusions found.

Related CPT Codes

99203CPT Code

Office or other outpatient visit for the evaluation and management of a new patient

Clinical Scenario

Used for initial consultations regarding oropharyngeal cancer.

Documentation Requirements

Document history, examination findings, and medical decision-making.

Specialty Considerations

Oncology specialists should ensure comprehensive documentation of cancer staging.

77427CPT Code

Radiation treatment management

Clinical Scenario

Used for patients receiving radiation therapy for oropharyngeal cancer.

Documentation Requirements

Radiation treatment plans and patient consent forms are required.

Specialty Considerations

Radiation oncologists must document the specific technique and dosage.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of malignancies, improving the accuracy of cancer registries and treatment tracking. C14 provides a broader category for less-defined malignancies, which can help in capturing cases that may have been misclassified under ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of malignancies, improving the accuracy of cancer registries and treatment tracking. C14 provides a broader category for less-defined malignancies, which can help in capturing cases that may have been misclassified under ICD-9.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of malignancies, improving the accuracy of cancer registries and treatment tracking. C14 provides a broader category for less-defined malignancies, which can help in capturing cases that may have been misclassified under ICD-9.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the significance of HPV status in coding C14?

HPV status is crucial as it influences treatment decisions and prognosis. Accurate documentation of HPV status is necessary for appropriate coding and management.

How do I differentiate between oropharyngeal and nasopharyngeal cancers for coding?

Oropharyngeal cancers typically involve the tonsils and base of the tongue, while nasopharyngeal cancers are located behind the nose. Accurate site documentation is essential for correct coding.