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ICD-10 Guide
ICD-10 CodesChapter 2: NeoplasmsC05

C05

Billable

Malignant neoplasm of palate

Chapter 2:Neoplasms

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

Code Description

ICD-10 C05 is a billable code used to indicate a diagnosis of malignant neoplasm of palate.

Key Diagnostic Point:

Malignant neoplasm of the palate refers to cancerous growths that occur in the hard or soft palate of the oral cavity. These tumors can arise from various cell types, including squamous cells, and may present as lesions that can be ulcerated or exophytic. Symptoms often include pain, difficulty swallowing, and changes in speech. Diagnosis typically involves a combination of clinical examination, imaging studies, and biopsy to confirm malignancy. Treatment options may include surgical resection, radiation therapy, and chemotherapy, depending on the stage and type of cancer. Multidisciplinary care is crucial, involving oncologists, oral surgeons, radiologists, and dental specialists to manage the complex needs of patients, including pain management, nutritional support, and rehabilitation. Early detection and intervention are key to improving outcomes for patients with malignant neoplasms of the palate.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and symptoms among patients
  • Need for precise staging and grading of the tumor
  • Potential for co-existing oral conditions complicating diagnosis
  • Multidisciplinary approach required for treatment planning

Audit Risk Factors

  • Inadequate documentation of tumor staging
  • Failure to capture co-existing conditions
  • Misclassification of tumor type
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans must be documented.

Common Clinical Scenarios

Patients presenting with oral lesions, difficulty swallowing, or unexplained weight loss.

Billing Considerations

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

Oral Surgery

Documentation Requirements

Surgical reports detailing the extent of resection and any reconstructive procedures performed.

Common Clinical Scenarios

Surgical intervention for tumor resection and management of complications.

Billing Considerations

Document any pre-operative assessments and post-operative care plans.

Coding Guidelines

Inclusion Criteria

Use C05 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the diagnosis, treatment, and any complications
  • Include specific details about the tumor's location, size, and histological type

Exclusion Criteria

Do NOT use C05 When
No specific exclusions found.

Related CPT Codes

21045CPT Code

Excision of malignant lesion of palate

Clinical Scenario

Used during surgical intervention for tumor resection.

Documentation Requirements

Surgical notes detailing the extent of excision and margins.

Specialty Considerations

Oral surgeons must document pre-operative assessments and post-operative care.

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 for oral cavity cancers.

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 for oral cavity cancers.

Reimbursement & Billing Impact

reimbursement processes for oral cavity cancers.

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 palate?

Common symptoms include pain in the oral cavity, difficulty swallowing, changes in speech, and the presence of non-healing ulcers or lesions.