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ICD-10 Guide
ICD-10 CodesC11.3

C11.3

Billable

Malignant neoplasm of anterior wall of nasopharynx

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

Code Description

ICD-10 C11.3 is a billable code used to indicate a diagnosis of malignant neoplasm of anterior wall of nasopharynx.

Key Diagnostic Point:

C11.3 refers to a malignant neoplasm located specifically in the anterior wall of the nasopharynx, which is the upper part of the throat behind the nose. This type of cancer is often associated with risk factors such as Epstein-Barr virus (EBV) infection and, in some cases, human papillomavirus (HPV). The nasopharynx is a critical area for both respiratory and digestive functions, and malignancies here can lead to significant complications, including obstruction of airflow and swallowing difficulties. Symptoms may include nasal obstruction, epistaxis (nosebleeds), and otitis media due to Eustachian tube dysfunction. Diagnosis typically involves imaging studies such as MRI or CT scans, along with biopsy for histological confirmation. Treatment often includes radiation therapy, which is the primary modality for localized disease, and may be combined with chemotherapy for advanced cases. The prognosis varies based on the stage at diagnosis and the patient's overall health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and symptoms of nasopharyngeal cancer.
  • Need for precise anatomical localization in documentation.
  • Differentiation from other head and neck cancers.
  • Potential for multiple treatment modalities affecting coding.

Audit Risk Factors

  • Inadequate documentation of HPV status.
  • Failure to specify the exact location of the neoplasm.
  • Misclassification of the tumor type or stage.
  • Lack of supporting imaging or biopsy reports.

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed descriptions of tumor location, size, and histological type.

Common Clinical Scenarios

Patients presenting with nasal obstruction, hearing loss, or neck masses.

Billing Considerations

Documentation must clearly indicate the relationship between symptoms and the neoplasm.

Oncology

Documentation Requirements

Comprehensive treatment plans including chemotherapy and radiation details.

Common Clinical Scenarios

Management of advanced nasopharyngeal cancer with multimodal therapy.

Billing Considerations

HPV status should be documented as it may affect prognosis and treatment.

Coding Guidelines

Inclusion Criteria

Use C11.3 When
  • Follow ICD
  • CM guidelines for neoplasms, ensuring accurate documentation of the site and type of malignancy
  • Include any relevant staging information and treatment details
  • malignant conditions

Exclusion Criteria

Do NOT use C11.3 When
  • Exclude benign neoplasms and other non

Related ICD-10 Codes

Related CPT Codes

31575CPT Code

Laryngoscopy, flexible, diagnostic

Clinical Scenario

Used for evaluating suspected nasopharyngeal malignancy.

Documentation Requirements

Document indications for the procedure and findings.

Specialty Considerations

Otolaryngologists should ensure thorough documentation of findings.

77401CPT Code

Radiation treatment delivery, external beam, per fraction

Clinical Scenario

Used in the treatment of nasopharyngeal cancer.

Documentation Requirements

Document treatment plan and response to therapy.

Specialty Considerations

Oncologists must document the radiation field and dosage.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 allows for more specific coding of nasopharyngeal cancers, improving data accuracy and treatment tracking. C11.3 provides a clear designation for malignancies in the anterior wall, which aids in clinical research and epidemiological studies.

ICD-9 vs ICD-10

The transition to ICD-10 allows for more specific coding of nasopharyngeal cancers, improving data accuracy and treatment tracking. C11.3 provides a clear designation for malignancies in the anterior wall, which aids in clinical research and epidemiological studies.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery
  • •
    National Cancer Institute - Nasopharyngeal Cancer

Coding & Billing References

  • •
    American Academy of Otolaryngology - Head and Neck Surgery
  • •
    National Cancer Institute - Nasopharyngeal Cancer

Frequently Asked Questions

What is the significance of HPV status in nasopharyngeal cancer?

HPV status can influence treatment decisions and prognosis. HPV-positive tumors may respond differently to treatment compared to HPV-negative tumors, making it essential to document this status.

How is C11.3 coded in the context of radiation therapy?

When coding for radiation therapy, ensure that C11.3 is linked to the treatment provided, including the type of radiation and the area treated.