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ICDxICD-10 Medical Coding

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v1.0.0
ICD-10 Guide
ICD-10 CodesChapter 2: NeoplasmsC04

C04

Billable

Malignant neoplasm of floor of mouth

Chapter 2:Neoplasms

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

Code Description

ICD-10 C04 is a billable code used to indicate a diagnosis of malignant neoplasm of floor of mouth.

Key Diagnostic Point:

Malignant neoplasm of the floor of the mouth is a type of oral cavity cancer that arises from the tissues located beneath the tongue and the area surrounding the submandibular glands. This neoplasm can present as a lump or ulceration in the floor of the mouth, often accompanied by symptoms such as pain, difficulty swallowing, and changes in speech. Risk factors include tobacco use, excessive alcohol consumption, and HPV infection. Diagnosis typically involves a thorough clinical examination, imaging studies, and biopsy to confirm malignancy. Treatment options may include surgical resection, radiation therapy, and chemotherapy, depending on the stage and extent of the disease. Multidisciplinary care is essential, involving oncologists, oral surgeons, radiologists, and dental specialists to manage the complex needs of patients, including pain management, nutritional support, and rehabilitation.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variability in staging and grading of tumors
  • Need for detailed documentation of treatment plans
  • Potential for multiple concurrent diagnoses
  • Complexity of surgical procedures and follow-up care

Audit Risk Factors

  • Inadequate documentation of tumor staging
  • Failure to capture all relevant diagnoses
  • Misclassification of tumor type or location
  • Lack of evidence for treatment modalities used

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed treatment plans, staging information, and follow-up care notes.

Common Clinical Scenarios

Patients undergoing chemotherapy or radiation therapy for oral malignancies.

Billing Considerations

Ensure accurate documentation of tumor response to treatment and any side effects experienced.

Oral Surgery

Documentation Requirements

Surgical notes, pathology reports, and post-operative care documentation.

Common Clinical Scenarios

Surgical resection of tumors in the floor of the mouth.

Billing Considerations

Document the extent of resection and any reconstructive procedures performed.

Coding Guidelines

Inclusion Criteria

Use C04 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the diagnosis, treatment, and any associated conditions
  • Include specific details about the tumor's location, size, and stage

Exclusion Criteria

Do NOT use C04 When
No specific exclusions found.

Related CPT Codes

21045CPT Code

Excision, malignant lesion, face, ears, eyelids, nose; excised diameter over 4.0 cm

Clinical Scenario

Used for surgical excision of malignant lesions in the oral cavity.

Documentation Requirements

Surgical notes detailing the size and location of the excised lesion.

Specialty Considerations

Oral surgeons must document the extent of resection and any reconstructive procedures.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of oral cavity malignancies, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of oral cavity malignancies, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American Cancer Society - Oral Cavity Cancer

Coding & Billing References

  • •
    American Cancer Society - Oral Cavity Cancer

Frequently Asked Questions

What are the common symptoms of malignant neoplasm of the floor of the mouth?

Common symptoms include pain, swelling, difficulty swallowing, and non-healing ulcers in the floor of the mouth.

How is a malignant neoplasm of the floor of the mouth diagnosed?

Diagnosis typically involves a clinical examination, imaging studies, and biopsy to confirm malignancy.