Is C12 a billable ICD-10-CM code?

Yes. C12 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does C12 sit in the tabular list?

Neoplasms (C00-D49), in the block Malignant neoplasms of lip, oral cavity and pharynx (C00-C14).

C12

C12 — Malignant neoplasm of pyriform sinus

Billable / specific codeICD-10-CM

C12 is a billable, specific ICD-10-CM code for malignant neoplasm of pyriform sinus. It is valid for submission on a claim.

Use additional code

Add a secondary code to capture the detail described below.

code to identify:
exposure to environmental tobacco smoke (Z77.22)
exposure to tobacco smoke in the perinatal period (P96.81)
history of tobacco dependence (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17.-)
tobacco use (Z72.0)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Malignant neoplasm of pyriform fossa

Risk adjustment

C12 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 21 Lymphoma and Other Cancers0.671 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

C12 is named in 59 Medicare coverage policies — 59 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
A52479Oral Anticancer Drugs - Policy Article
A52479Oral Anticancer Drugs - Policy Article
A52479Oral Anticancer Drugs - Policy Article

Questions about C12

Is C12 a billable ICD-10-CM code?: Yes. C12 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does C12 sit in the tabular list?: Neoplasms (C00-D49), in the block Malignant neoplasms of lip, oral cavity and pharynx (C00-C14).