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v1.0.0
ICD-10 Guide
ICD-10 CodesC06.2

C06.2

Billable

Malignant neoplasm of retromolar area

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

Code Description

ICD-10 C06.2 is a billable code used to indicate a diagnosis of malignant neoplasm of retromolar area.

Key Diagnostic Point:

The retromolar area is located at the back of the mouth, behind the last molar teeth. Malignant neoplasms in this region are often squamous cell carcinomas, which are the most common type of oral cavity cancer. These tumors can arise from the mucosal lining and may present with symptoms such as pain, swelling, difficulty swallowing, and changes in oral function. Risk factors include tobacco use, alcohol consumption, and human papillomavirus (HPV) infection. Diagnosis typically involves a thorough clinical examination, imaging studies, and biopsy to confirm malignancy. Treatment often requires a multidisciplinary approach, including surgical resection, radiation therapy, and chemotherapy, depending on the stage and extent of the disease. Dental considerations are crucial, as patients may require dental evaluations prior to treatment to manage oral health and prevent complications during and after cancer therapy. Regular follow-ups are essential for monitoring recurrence and managing any long-term effects of treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between benign and malignant lesions in the oral cavity.
  • Understanding the staging of oral cancers and its impact on coding.
  • The need for comprehensive documentation of treatment plans and outcomes.
  • Variability in clinical presentation and symptoms among patients.

Audit Risk Factors

  • Inadequate documentation of the malignancy type and stage.
  • Failure to document the multidisciplinary treatment approach.
  • Misclassification of the neoplasm as benign.
  • Lack of follow-up documentation post-treatment.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed pathology reports, imaging studies, treatment plans, and follow-up notes.

Common Clinical Scenarios

Diagnosis and management of oral cancers, treatment planning, and monitoring for recurrence.

Billing Considerations

Ensure accurate staging and documentation of treatment response.

Dentistry

Documentation Requirements

Dental evaluations, treatment notes, and coordination with oncology for pre- and post-treatment care.

Common Clinical Scenarios

Management of oral health in cancer patients, including extraction of teeth prior to radiation therapy.

Billing Considerations

Document any dental interventions and their relation to cancer treatment.

Coding Guidelines

Inclusion Criteria

Use C06.2 When
  • Follow the official ICD
  • CM coding guidelines for neoplasms, ensuring accurate documentation of the site, type, and behavior of the tumor
  • Include any relevant staging information and treatment details

Exclusion Criteria

Do NOT use C06.2 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

21010CPT Code

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

Clinical Scenario

Used when excising a malignant lesion in the retromolar area.

Documentation Requirements

Document the size of the lesion and the extent of excision.

Specialty Considerations

Oncology specialists should ensure accurate coding based on the surgical approach.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 allows for more specific coding of oral cavity malignancies, improving the accuracy of data collection and reimbursement processes. C06.2 provides a clear distinction between malignant and benign lesions, enhancing clinical management.

ICD-9 vs ICD-10

The transition to ICD-10 allows for more specific coding of oral cavity malignancies, improving the accuracy of data collection and reimbursement processes. C06.2 provides a clear distinction between malignant and benign lesions, enhancing clinical management.

Reimbursement & Billing Impact

reimbursement processes. C06.2 provides a clear distinction between malignant and benign lesions, enhancing clinical management.

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 a malignant neoplasm in the retromolar area?

Common symptoms include pain, swelling, difficulty swallowing, and changes in oral function. Patients may also present with ulcers or lesions that do not heal.