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ICD-10 Guide
ICD-10 CodesC10.3

C10.3

Billable

Malignant neoplasm of posterior wall of oropharynx

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

Code Description

ICD-10 C10.3 is a billable code used to indicate a diagnosis of malignant neoplasm of posterior wall of oropharynx.

Key Diagnostic Point:

C10.3 refers to a malignant neoplasm located specifically in the posterior wall of the oropharynx, which is a part of the throat situated behind the oral cavity. This area includes the soft palate, the base of the tongue, and the tonsils. Oropharyngeal cancers, including those coded as C10.3, are often associated with risk factors such as tobacco use, alcohol consumption, and human papillomavirus (HPV) infection. HPV-positive oropharyngeal cancers have been on the rise, particularly among younger populations, and are known to have a better prognosis compared to HPV-negative cases. Treatment typically involves a combination of surgery, radiation therapy, and chemotherapy, depending on the stage and location of the tumor. Radiation therapy is a common treatment modality, especially for localized tumors, and may be used as a primary treatment or adjuvantly after surgery. Accurate coding of C10.3 requires thorough documentation of the tumor's location, size, and HPV status, as these factors significantly influence treatment decisions and outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for precise anatomical localization of the tumor
  • Differentiation between HPV-positive and HPV-negative cases
  • Variability in treatment approaches based on staging
  • Documentation of patient history related to risk factors

Audit Risk Factors

  • Inadequate documentation of HPV status
  • Failure to specify the exact location of the tumor
  • Misclassification of tumor stage
  • Lack of clarity in treatment plans

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Diagnosis and treatment planning for oropharyngeal cancers, including staging and HPV testing.

Billing Considerations

Ensure accurate documentation of tumor characteristics and treatment response.

Radiation Oncology

Documentation Requirements

Radiation treatment plans, dosimetry, and follow-up assessments must be included.

Common Clinical Scenarios

Patients receiving radiation therapy for oropharyngeal cancers, including pre- and post-treatment evaluations.

Billing Considerations

Document the radiation fields and doses accurately to support coding.

Coding Guidelines

Inclusion Criteria

Use C10.3 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the diagnosis is confirmed
  • Include additional codes for any related conditions or complications

Exclusion Criteria

Do NOT use C10.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99203CPT Code

Office or other outpatient visit for the evaluation and management of a new patient

Clinical Scenario

Used for initial consultation regarding C10.3 diagnosis.

Documentation Requirements

Document history, examination findings, and treatment plan.

Specialty Considerations

Oncology specialists should ensure comprehensive documentation.

77427CPT Code

Radiation treatment delivery, per fraction

Clinical Scenario

Used during radiation therapy for C10.3.

Documentation Requirements

Document treatment fields and doses.

Specialty Considerations

Radiation oncologists must detail the treatment plan.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of oropharyngeal cancers, improving data accuracy and treatment tracking. C10.3 provides a clear distinction for malignant neoplasms of the posterior wall, which aids in research and treatment outcomes analysis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of oropharyngeal cancers, improving data accuracy and treatment tracking. C10.3 provides a clear distinction for malignant neoplasms of the posterior wall, which aids in research and treatment outcomes analysis.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of oropharyngeal cancers, improving data accuracy and treatment tracking. C10.3 provides a clear distinction for malignant neoplasms of the posterior wall, which aids in research and treatment outcomes analysis.

Resources

Clinical References

  • •
    American Cancer Society - Oropharyngeal Cancer

Coding & Billing References

  • •
    American Cancer Society - Oropharyngeal Cancer

Frequently Asked Questions

What is the significance of HPV status in coding C10.3?

HPV status is crucial as it influences treatment options and prognosis. Accurate documentation of HPV status is necessary for coding and treatment planning.