D16.4 — Benign neoplasm of bones of skull and face
D16.4 is a billable, specific ICD-10-CM code for benign neoplasm of bones of skull and face. It is valid for submission on a claim.
Excludes2 — not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
- benign neoplasm of lower jaw bone (D16.5)
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Benign neoplasm of maxilla (superior)
- Benign neoplasm of orbital bone
- Keratocyst of maxilla
- Keratocystic odontogenic tumor of maxilla
Other codes that can never be billed with D16.4
These codes carry an Excludes1 note pointing at D16.4. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading D16.4 alone.
Risk adjustment
D16.4 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
D16.4 is named in 17 Medicare coverage policies — 17 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A55315Billing and Coding: Proton Beam Therapy
- A56464Billing and Coding: Flow Cytometry
- A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
- A56587Billing and Coding: Cosmetic and Reconstructive Surgery
How D16.4 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to D16.4.
- Cyst›calcifying odontogenic›upper jaw(bone) (maxilla)
Related codes at this level
Codes that share D16. If D16.4 is not quite right, the correct code is usually one of these.
- D16.0Benign neoplasm of scapula and long bones of upper limb
- D16.1Benign neoplasm of short bones of upper limb
- D16.2Benign neoplasm of long bones of lower limb
- D16.3Benign neoplasm of short bones of lower limb
- D16.5Benign neoplasm of lower jaw bone
- D16.6Benign neoplasm of vertebral column
- D16.7Benign neoplasm of ribs, sternum and clavicle
- D16.8Benign neoplasm of pelvic bones, sacrum and coccyx
- D16.9Benign neoplasm of bone and articular cartilage, unspecified
Questions about D16.4
- Is D16.4 a billable ICD-10-CM code?
- Yes. D16.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does D16.4 sit in the tabular list?
- Neoplasms (C00-D49), in the block Benign neoplasms, except benign neuroendocrine tumors (D10-D36).