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ICD-10 Guide
ICD-10 CodesC04.0

C04.0

Billable

Malignant neoplasm of anterior floor of mouth

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

Code Description

ICD-10 C04.0 is a billable code used to indicate a diagnosis of malignant neoplasm of anterior floor of mouth.

Key Diagnostic Point:

The malignant neoplasm of the anterior floor of the mouth refers to cancerous growths located in the front section of the oral cavity, specifically beneath the tongue and towards the front of the mouth. This area is critical for various functions, including speech, swallowing, and taste. The neoplasm may arise from squamous cells, which are the predominant cell type in the oral mucosa. Symptoms often include persistent sores, difficulty swallowing, and changes in speech. Risk factors include tobacco use, excessive alcohol consumption, and HPV infection. Diagnosis typically involves a biopsy, imaging studies, and thorough clinical examination. Treatment options may include surgery, radiation therapy, and chemotherapy, necessitating a multidisciplinary approach involving oncologists, oral surgeons, and dental specialists to manage both the cancer and its effects on oral health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation between benign and malignant lesions
  • Need for precise anatomical localization
  • Potential for multiple treatment modalities
  • Variability in clinical presentation

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the type of malignancy
  • Lack of staging information
  • Misclassification of the site of the neoplasm

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with non-healing ulcers or lesions in the anterior floor of the mouth.

Billing Considerations

Ensure accurate staging and grading of the tumor for appropriate coding.

Oral Surgery

Documentation Requirements

Surgical reports detailing excision margins and pathology results.

Common Clinical Scenarios

Surgical intervention for tumor removal and reconstruction of the oral cavity.

Billing Considerations

Document any complications or additional procedures performed during surgery.

Coding Guidelines

Inclusion Criteria

Use C04.0 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the site, type, and stage of the malignancy
  • Include any relevant treatment information and patient history

Exclusion Criteria

Do NOT use C04.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

21010CPT Code

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

Clinical Scenario

Used when excising a malignant neoplasm from the anterior floor of the mouth.

Documentation Requirements

Surgical reports must detail the size and location of the excised lesion.

Specialty Considerations

Oral surgeons must document margins and any reconstructive procedures performed.

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 anterior floor of the mouth?

Common symptoms include persistent sores, difficulty swallowing, changes in speech, and lumps or swelling in the mouth.