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ICD-10 Guide
ICD-10 CodesChapter 2: NeoplasmsC06

C06

Billable

Malignant neoplasm of other and unspecified parts of mouth

Chapter 2:Neoplasms

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

Code Description

ICD-10 C06 is a billable code used to indicate a diagnosis of malignant neoplasm of other and unspecified parts of mouth.

Key Diagnostic Point:

C06 refers to malignant neoplasms located in the oral cavity that are not classified under more specific codes. This includes cancers arising from various tissues in the mouth, such as the floor of the mouth, the gums, and the hard palate. These neoplasms can present with symptoms such as persistent sores, lumps, or swelling in the mouth, difficulty swallowing, and changes in voice. The diagnosis often requires a biopsy and imaging studies to determine the extent of the disease. Treatment typically involves a multidisciplinary approach, including surgical intervention, radiation therapy, and chemotherapy, depending on the stage and location of the cancer. Dental considerations are crucial, as oral health can significantly impact treatment outcomes and quality of life for patients. Regular dental evaluations and management of oral complications are essential components of care for patients with oral malignancies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of oral cavity sites
  • Need for precise staging information
  • Differentiation from benign lesions
  • Multidisciplinary treatment approaches

Audit Risk Factors

  • Inadequate documentation of tumor location
  • Failure to specify the type of malignancy
  • Lack of staging information
  • Misclassification of benign versus malignant lesions

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, and treatment plans.

Common Clinical Scenarios

Diagnosis and management of oral cancers, including staging and treatment response.

Billing Considerations

Ensure accurate coding of tumor type and location, as well as treatment modalities.

Dentistry

Documentation Requirements

Comprehensive dental evaluations, treatment notes, and referrals to specialists.

Common Clinical Scenarios

Management of oral complications from cancer treatment, such as mucositis or xerostomia.

Billing Considerations

Coordination with oncologists for comprehensive care and documentation of oral health status.

Coding Guidelines

Inclusion Criteria

Use C06 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that the code is used only when the malignancy is confirmed and documented
  • Include any relevant staging information and specify the site of the neoplasm when possible

Exclusion Criteria

Do NOT use C06 When
No specific exclusions found.

Related CPT Codes

CPT 21010CPT Code

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

Clinical Scenario

Used when excising a malignant neoplasm of the oral cavity.

Documentation Requirements

Document the size of the lesion and the surgical approach.

Specialty Considerations

Oncologists and oral surgeons should coordinate documentation for accurate coding.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of oral malignancies, improving the accuracy of data collection and reimbursement processes. C06 provides a necessary code for less common oral cancers that may not fit into more specific categories.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of oral malignancies, improving the accuracy of data collection and reimbursement processes. C06 provides a necessary code for less common oral cancers that may not fit into more specific categories.

Reimbursement & Billing Impact

reimbursement processes. C06 provides a necessary code for less common oral cancers that may not fit into more specific categories.

Resources

Clinical References

  • •
    American Cancer Society - Oral Cavity Cancer

Coding & Billing References

  • •
    American Cancer Society - Oral Cavity Cancer

Frequently Asked Questions

What types of cancers are classified under C06?

C06 includes malignant neoplasms of the oral cavity that do not fall under more specific codes, such as cancers of the floor of the mouth, gums, or hard palate.

How can I differentiate between malignant and benign lesions in the mouth?

Differentiation typically requires a biopsy and histopathological examination, along with clinical evaluation of symptoms and imaging studies.