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v1.0.0
ICD-10 Guide
ICD-10 CodesC11.0

C11.0

Billable

Malignant neoplasm of superior wall of nasopharynx

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

Code Description

ICD-10 C11.0 is a billable code used to indicate a diagnosis of malignant neoplasm of superior wall of nasopharynx.

Key Diagnostic Point:

C11.0 refers to a malignant neoplasm located specifically in the superior wall of the nasopharynx, which is the upper part of the throat behind the nose. This area is critical for both respiratory and digestive functions and is often involved in various head and neck cancers. The nasopharynx is particularly susceptible to malignancies associated with the Epstein-Barr virus (EBV) and human papillomavirus (HPV), with HPV-positive tumors showing distinct biological behavior and treatment responses. Symptoms may include nasal obstruction, epistaxis (nosebleeds), hearing loss, and neck masses due to lymphadenopathy. Diagnosis typically involves imaging studies such as MRI or CT scans, along with biopsy for histological confirmation. Treatment often includes a combination of radiation therapy and chemotherapy, especially for advanced stages. The prognosis can vary significantly based on the stage at diagnosis, HPV status, and response to treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation between benign and malignant neoplasms
  • Need for precise anatomical localization
  • Variability in treatment protocols based on HPV status
  • Potential for metastasis requiring additional coding

Audit Risk Factors

  • Inadequate documentation of HPV status
  • Failure to document staging of the cancer
  • Misclassification of tumor type (benign vs malignant)
  • Lack of clarity in treatment plans

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed clinical notes on symptoms, imaging results, and biopsy findings.

Common Clinical Scenarios

Patients presenting with neck masses, nasal obstruction, or unexplained epistaxis.

Billing Considerations

Ensure thorough documentation of the tumor's location and any associated symptoms.

Oncology

Documentation Requirements

Comprehensive treatment plans, including chemotherapy and radiation therapy details.

Common Clinical Scenarios

Management of patients undergoing treatment for nasopharyngeal carcinoma.

Billing Considerations

Documenting the patient's HPV status is crucial for treatment decisions.

Coding Guidelines

Inclusion Criteria

Use C11.0 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the tumor's location, histology, and any relevant treatment details
  • Include staging information when available

Exclusion Criteria

Do NOT use C11.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

70450CPT Code

CT scan of the head or neck

Clinical Scenario

Used for imaging to assess the extent of the nasopharyngeal tumor.

Documentation Requirements

Document the reason for the scan and findings.

Specialty Considerations

Otolaryngologists and oncologists should ensure imaging correlates with clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of nasopharyngeal cancers, improving data accuracy and treatment tracking. C11.0 provides a clear distinction for malignant neoplasms, facilitating better patient management and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of nasopharyngeal cancers, improving data accuracy and treatment tracking. C11.0 provides a clear distinction for malignant neoplasms, facilitating better patient management and research.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of nasopharyngeal cancers, improving data accuracy and treatment tracking. C11.0 provides a clear distinction for malignant neoplasms, facilitating better patient management and research.

Resources

Clinical References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery

Coding & Billing References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery

Frequently Asked Questions

What is the significance of HPV status in coding C11.0?

HPV status is crucial as it influences treatment decisions and prognosis. Accurate documentation of HPV status is necessary for coding and can affect the management of the patient.