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v1.0.0
ICD-10 Guide
ICD-10 CodesC06.9

C06.9

Billable

Malignant neoplasm of mouth, unspecified

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

Code Description

ICD-10 C06.9 is a billable code used to indicate a diagnosis of malignant neoplasm of mouth, unspecified.

Key Diagnostic Point:

C06.9 refers to a malignant neoplasm located in the mouth that is unspecified. This encompasses a variety of cancers that may arise in the oral cavity, including squamous cell carcinoma, adenocarcinoma, and others. The oral cavity includes the lips, gums, tongue, floor of the mouth, hard palate, and soft palate. Symptoms may include persistent sores, lumps, or growths in the mouth, difficulty swallowing, and changes in speech. Diagnosis typically involves a thorough clinical examination, imaging studies, and biopsy to confirm malignancy. Treatment often requires a multidisciplinary approach, including surgical intervention, radiation therapy, and chemotherapy, depending on the stage and type of cancer. Dental considerations are crucial, as oral health can significantly impact treatment outcomes and quality of life. 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 presentation and symptoms of oral cancers
  • Need for precise documentation of tumor location and type
  • Differentiation from benign lesions and other oral conditions
  • Potential for multiple treatment modalities and their documentation

Audit Risk Factors

  • Inadequate documentation of tumor characteristics
  • Failure to specify the exact location of the neoplasm
  • Lack of interdisciplinary notes from dental and oncology specialists
  • 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 staging and documentation of treatment response to support coding.

Dentistry

Documentation Requirements

Comprehensive dental evaluations, treatment notes, and oral health assessments.

Common Clinical Scenarios

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

Billing Considerations

Coordination with oncology for managing oral health during cancer treatment.

Coding Guidelines

Inclusion Criteria

Use C06.9 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the malignancy's location and type
  • Include any relevant staging information and treatment details

Exclusion Criteria

Do NOT use C06.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

CPT 21045CPT Code

Biopsy of oral cavity

Clinical Scenario

Used when a biopsy is performed to confirm malignancy.

Documentation Requirements

Pathology report and clinical notes detailing the biopsy procedure.

Specialty Considerations

Oncology and dentistry must 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 data accuracy and facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of oral malignancies, improving data accuracy and facilitating better patient management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of oral malignancies, improving data accuracy and facilitating better patient management.

Resources

Clinical References

  • •
    American Cancer Society - Oral Cavity Cancer

Coding & Billing References

  • •
    American Cancer Society - Oral Cavity Cancer

Frequently Asked Questions

What is the significance of coding C06.9?

C06.9 is crucial for identifying patients with unspecified malignant neoplasms of the mouth, which helps in tracking treatment outcomes and resource allocation.