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ICD-10 Guide
ICD-10 CodesD16.5

D16.5

Billable

Benign neoplasm of lower jaw bone

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

Code Description

ICD-10 D16.5 is a billable code used to indicate a diagnosis of benign neoplasm of lower jaw bone.

Key Diagnostic Point:

Benign neoplasms of the lower jaw bone, also known as the mandible, are non-cancerous growths that can arise from various tissues within the jaw. These neoplasms may include osteomas, odontogenic tumors, and fibromas, among others. Clinically, they may present as asymptomatic masses or may cause symptoms such as swelling, pain, or functional impairment depending on their size and location. Diagnosis typically involves imaging studies such as X-rays, CT scans, or MRIs, and may require a biopsy for definitive histological evaluation. While benign, these neoplasms can occasionally exhibit aggressive behavior or local invasion, necessitating careful monitoring and, in some cases, surgical intervention. Surveillance is crucial to ensure that these lesions do not progress or transform into malignant forms, although the risk of malignant transformation is generally low. Regular follow-ups and imaging may be recommended based on the specific type of neoplasm and its characteristics.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of benign neoplasm types that can affect coding specificity.
  • Need for accurate documentation of symptoms and imaging findings.
  • Potential for misclassification with malignant neoplasms.
  • Variability in treatment approaches and follow-up requirements.

Audit Risk Factors

  • Inadequate documentation of the neoplasm's characteristics.
  • Failure to document follow-up care or surveillance plans.
  • Misclassification of benign neoplasms as malignant.
  • Lack of imaging or biopsy results in the medical record.

Specialty Focus

Medical Specialties

Oral and Maxillofacial Surgery

Documentation Requirements

Detailed surgical notes, imaging studies, and pathology reports.

Common Clinical Scenarios

Surgical excision of a benign jaw neoplasm, management of post-operative complications.

Billing Considerations

Ensure clear documentation of the neoplasm type and any histological findings.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing findings and recommendations.

Common Clinical Scenarios

Imaging for evaluation of jaw masses, follow-up imaging for known benign neoplasms.

Billing Considerations

Accurate coding based on imaging findings and correlation with clinical symptoms.

Coding Guidelines

Inclusion Criteria

Use D16.5 When
  • According to ICD
  • 10 coding guidelines, D16
  • 5 should be used when a benign neoplasm of the lower jaw is confirmed through imaging or biopsy
  • Accurate documentation of the diagnosis and treatment plan is essential for proper coding

Exclusion Criteria

Do NOT use D16.5 When
  • Exclusion criteria include malignant neoplasms or conditions that mimic benign neoplasms

Related ICD-10 Codes

Related CPT Codes

21010CPT Code

Incision and drainage of abscess, soft tissue, head and neck

Clinical Scenario

Used when a benign neoplasm causes secondary infection.

Documentation Requirements

Document the presence of infection and the procedure performed.

Specialty Considerations

Oral and Maxillofacial Surgery must ensure accurate coding based on the underlying condition.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of benign neoplasms, improving the accuracy of data collection and reimbursement processes. D16.5 provides a clear classification for benign neoplasms of the lower jaw, facilitating better patient management and tracking of treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of benign neoplasms, improving the accuracy of data collection and reimbursement processes. D16.5 provides a clear classification for benign neoplasms of the lower jaw, facilitating better patient management and tracking of treatment outcomes.

Reimbursement & Billing Impact

reimbursement processes. D16.5 provides a clear classification for benign neoplasms of the lower jaw, facilitating better patient management and tracking of treatment outcomes.

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 are the common symptoms of a benign neoplasm of the lower jaw?

Common symptoms include swelling, pain, and functional impairment, although many patients may be asymptomatic.

How often should patients with benign neoplasms of the lower jaw be monitored?

Surveillance frequency depends on the specific type of neoplasm and its characteristics, but regular follow-ups are generally recommended.