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v1.0.0
ICD-10 Guide
ICD-10 CodesC31.3

C31.3

Billable

Malignant neoplasm of sphenoid sinus

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

Code Description

ICD-10 C31.3 is a billable code used to indicate a diagnosis of malignant neoplasm of sphenoid sinus.

Key Diagnostic Point:

Malignant neoplasm of the sphenoid sinus is a rare but serious condition characterized by the uncontrolled growth of malignant cells within the sphenoid sinus, which is located behind the nose and between the eyes. This type of cancer can arise from the epithelial lining of the sinus or may be a metastatic disease from other primary sites. Symptoms often include nasal obstruction, facial pain, headaches, and visual disturbances due to the proximity of the sphenoid sinus to the optic nerve. Diagnosis typically involves imaging studies such as CT or MRI scans to assess the extent of the tumor and its impact on surrounding structures. Treatment options may include surgical resection, radiation therapy, and chemotherapy, depending on the stage and aggressiveness of the tumor. Accurate coding for this condition is crucial for appropriate treatment planning and reimbursement, as it requires a multidisciplinary approach involving otolaryngologists, oncologists, and radiologists.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Rarity of the condition leading to limited coding experience
  • Need for precise documentation of tumor staging and location
  • Variability in treatment approaches requiring detailed coding
  • Potential for misclassification with benign neoplasms

Audit Risk Factors

  • Inadequate documentation of tumor characteristics
  • Failure to specify the extent of disease
  • Misalignment between diagnosis and treatment codes
  • Lack of imaging reports to support the diagnosis

Specialty Focus

Medical Specialties

Otolaryngology

Documentation Requirements

Detailed surgical notes, imaging results, and pathology reports are essential for accurate coding.

Common Clinical Scenarios

Patients presenting with nasal obstruction, facial pain, or visual disturbances requiring imaging and potential surgical intervention.

Billing Considerations

Ensure clear documentation of the tumor's location and any associated complications.

Oncology

Documentation Requirements

Comprehensive treatment plans, including chemotherapy and radiation therapy details, must be documented.

Common Clinical Scenarios

Management of patients with diagnosed malignant neoplasms of the sphenoid sinus requiring multidisciplinary care.

Billing Considerations

Accurate staging and treatment response documentation are critical for coding and billing.

Coding Guidelines

Inclusion Criteria

Use C31.3 When
  • Follow official coding guidelines for neoplasms, ensuring accurate documentation of the primary site and any metastatic involvement
  • Include staging information when available

Exclusion Criteria

Do NOT use C31.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

31256CPT Code

Nasal/sinus endoscopy, surgical

Clinical Scenario

Used for surgical intervention in cases of malignant neoplasm of the sphenoid sinus.

Documentation Requirements

Surgical notes detailing the procedure and findings.

Specialty Considerations

Otolaryngologists must document the extent of resection and any complications.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of malignancies, improving the accuracy of data collection and reimbursement processes for conditions like C31.3.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of malignancies, improving the accuracy of data collection and reimbursement processes for conditions like C31.3.

Reimbursement & Billing Impact

reimbursement processes for conditions like C31.3.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What imaging studies are recommended for diagnosing C31.3?

CT and MRI scans are the preferred imaging modalities for evaluating the sphenoid sinus and determining the extent of malignancy.