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.

Check C12 with the rest of the claim: free scrubber

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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

C12 is named in 57 Medicare coverage policies: 57 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
A52479Oral Anticancer Drugs - Policy Article
A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
A54111Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders

Code history

Unchanged in every release from FY2024 to FY2027.