Oral Cancer ICD 10 Code

Refresher: What are ICD-10 codes?

ICD-10 codes are part of a system that physicians and healthcare providers use to do the following:

• Classify all diagnoses, symptoms, and procedures
• Code all diagnoses, symptoms, and procedures

These codes provide the necessary details to be specific with diagnoses and ensure morbidity classification in the United States [¹].

However, the US version came about after a collaboration between the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). Within ICD-10, there are two sets of medical codes [²]:

• The ICD-10-PCS (useful for coding procedures for inpatient settings)
• The ICD-10-CM (useful in disease diagnosis)

The term "ICD" stands for the International Classification of Diseases. "10," on the other hand, denotes the current edition. The predecessor of this edition was the ICD-9.

There are two types of tumors: Primary or malignant neoplasms and secondary or metastasized tumors. ICD-10 codes are different for both categories.

Currently, there are around 68,000 ICD-10-CM codes and 70,000 ICD-10-PCS codes for malignant neoplasms [³].

What is the ICD-10 Code for oral cancer?

Cancer is a condition in which the cells in your body start multiplying abnormally. This uncontrollable multiplication results in what we call a malignant neoplasm (abnormal tissue growth). As a result, malignant cells attack healthy cells in the body, causing a significant reduction of the latter.

Oral cancer is an umbrella term that includes cancers of the back of the throat and the mouth. It develops in the following areas:

• On the tongue
• Under the tongue
• At the base of the tongue
• On the tissue lining the gums and mouth
• At the back of the mouth
• In the throat

Since this type of cancer spreads fairly quickly, it’s important to detect it in time. Oral cancer is more common in people over 40 years of age, and it affects more men than women. In most cases, these cancers are a result of lifelong or excessive alcohol use, tobacco use, or the HPV (Human Papilloma Virus) infection.

Currently, this type of cancer accounts for 3% of all cancer diagnoses in the US every year. There are roughly 53,000 new cases annually. Fortunately, there are ways to diagnose and treat oral cancer at an early stage and prevent it from metastasizing.

Initially, healthcare professionals may recommend screening tests. But it does not necessarily mean that you have oral cancer. Currently, there are no routine or standard screening tests for oral cavity and nasopharyngeal cancers. Your doctor may recommend certain tests after a careful examination of your symptoms. If the screening test results are not normal, your healthcare professional will then recommend diagnostic tests.

The ICD-10-CM diagnosis code for oral cancer is C06, which represents the malignant neoplasm of other and unspecified parts of the mouth. The code is applicable to malignant neoplasm of the minor salivary gland and malignant neoplasm of oral cavity NOS.

Primary oral cancer ICD-10 Code: C06

The ICD-10 code C06 is used to categorize malignant neoplasm of the oral. C06 is an ICD-10-CM code that is billable and is used to indicate the diagnosis of oral cancer for reimbursement purposes. This code became effective on October 1, 2022.

Primary oral cancer ICD Code C06 lookup

Below is a table of the ICD-10 Oral Cancer codes for primary oral cancers, which are classified under C06 as "malignant neoplasm of other and unspecified parts of the mouth.”

C06: Malignant neoplasm of other and unspecified parts of the mouth

Types of oral cancer coded under C06.

Further exploration of C06 codes can reveal more details about the specific part of the mouth that has been affected and any overlapping sites. Below are a few examples of common types of oral cancer that are covered under C06:

• Buccal mucosa cancer
• Vestibule of mouth cancer
• Retromolar trigone carcinoma
• Salivary gland cancer

In other words, a diagnosis is coded C06 if it is a primary malignant neoplasm of the mouth. For example, a patient diagnosed with malignant neoplasm of the mouth, unspecified, would be coded with C06.9, which indicates that you have cancer in your mouth.

When compared to ICD-9, ICD-10 adds more detail to how a patient’s oral cancer is coded. ICD-9 uses numeric codes with only occasional E and V alphanumeric codes. ICD-10 uses entirely alphanumeric codes and has codes of up to seven digits.

While there are benefits, there are also costs associated with the transition to ICD 10. The costs have to do with learning new coding policies, training the staff to learn new policies, increased administrative time, learning new documentation practices, etc.

Then, there's the risk of inaccurate coding. Even if a single digit is missing, it can lead to a completely different diagnosis and a completely different approach to treating cancer. It may also lead to issues with healthcare insurance if a person is diagnosed with a type of cancer they don't have.

Oral cancers excluded from ICD-10 C06

Malignant neoplasm of other and unspecified parts of mouth C06 exclude the following types of oral cancer:

• Malignant neoplasm of the dorsal surface of the base of the tongue (covered under C01) [⁴]
• Malignant neoplasm of floor of the mouth, unspecified (covered under C04.9) [⁵]
• Malignant neoplasm of overlapping sites of the lip, oral cavity, and pharynx (C14.8) [⁶]

It is also worth mentioning that squamous cell carcinoma, one of the most common types of oral cancer, is not a part of C06. Most oral cancers tend to have similar symptoms despite their different coding systems, including sore lips, white and red patches in the mouth, etc.

It is important to get these symptoms checked by a doctor at the earliest for accurate diagnosis.

Conclusion

The ICD 10 code for oral or mouth cancers depends on the specific location of the primary neoplasm and whether it affects the lips, tongue, and floor of the mouth. Primary oral cancer falls under ICD-10 C06, but it does not include the cancer of the floor of the mouth, the base of the tongue, and overlapping sites of the lip and oral cavity.

All the information contained in this article may only be used for reference purposes and does not replace professional advice from a healthcare professional. If you experience any oral cancer symptoms, please visit your doctor for any health-related questions, including the ICD-10 codes discussed here.