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v1.0.0
ICD-10 Guide
ICD-10 CodesC14.0

C14.0

Billable

Malignant neoplasm of pharynx, unspecified

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

Code Description

ICD-10 C14.0 is a billable code used to indicate a diagnosis of malignant neoplasm of pharynx, unspecified.

Key Diagnostic Point:

C14.0 refers to malignant neoplasms located in the pharynx, which is a part of the throat situated behind the nose and mouth. This code is used when the specific site of the neoplasm within the pharynx is not specified. Pharyngeal cancers can be categorized into oropharyngeal and nasopharyngeal cancers, with the latter often associated with the Epstein-Barr virus (EBV) and human papillomavirus (HPV). Oropharyngeal cancers are frequently linked to HPV, particularly HPV type 16, which has been recognized as a significant risk factor. Symptoms may include sore throat, difficulty swallowing, and unexplained weight loss. Treatment often involves a combination of surgery, radiation therapy, and chemotherapy, with radiation therapy being a common approach for localized tumors. Accurate coding is essential for appropriate treatment planning and reimbursement, as well as for tracking epidemiological trends in cancer incidence.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation regarding the specific site of the neoplasm
  • Differentiation between oropharyngeal and nasopharyngeal cancers
  • HPV status documentation and its implications for treatment
  • Potential for overlapping symptoms with benign conditions

Audit Risk Factors

  • Inadequate documentation of the specific site of the neoplasm
  • Failure to document HPV status
  • Lack of clarity in treatment plans and outcomes
  • Inconsistent use of terminology in clinical notes

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with symptoms of throat cancer, undergoing radiation therapy, or receiving HPV-related treatment.

Billing Considerations

Ensure that HPV status is documented, as it may influence treatment options and prognosis.

Otolaryngology

Documentation Requirements

Comprehensive examination findings, imaging results, and surgical notes.

Common Clinical Scenarios

Patients with obstructive symptoms, dysphagia, or neck masses requiring biopsy.

Billing Considerations

Accurate description of the tumor's location and characteristics is crucial for coding.

Coding Guidelines

Inclusion Criteria

Use C14.0 When
  • According to ICD
  • 10 coding guidelines, C14
  • 0 should be used when the specific site of the pharyngeal neoplasm is not documented
  • Coders should ensure that all relevant clinical information is captured to support the diagnosis

Exclusion Criteria

Do NOT use C14.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99203CPT Code

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

Clinical Scenario

Used when a new patient presents with symptoms suggestive of pharyngeal cancer.

Documentation Requirements

Document history, examination findings, and any diagnostic tests performed.

Specialty Considerations

Oncologists should ensure that all relevant cancer history is included.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of cancers, which aids in tracking epidemiological data and improving treatment outcomes. C14.0 serves as a catch-all for unspecified pharyngeal malignancies, 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 cancers, which aids in tracking epidemiological data and improving treatment outcomes. C14.0 serves as a catch-all for unspecified pharyngeal malignancies, but coders should strive for specificity when possible.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American Cancer Society - Pharyngeal Cancer

Coding & Billing References

  • •
    American Cancer Society - Pharyngeal Cancer

Frequently Asked Questions

What is the significance of HPV status in coding C14.0?

HPV status is crucial as it influences treatment options and prognosis. Coders should ensure that this information is documented to support the diagnosis and treatment plan.