KEYTRUDA FOR RECURRENT OR METASTATIC HNSCC
Download possible relevant diagnosis codes for HNSCC

The following codes as of November 2018 are provided as a reference and may be relevant when billing for KEYTRUDA and its administration. Consult the relevant manual and/or other guidelines for a description of each code to determine the appropriateness of its use and for information on additional codes. Diagnosis codes should be selected only by a health care professional. You are solely responsible for determining the appropriate codes and for any action you take in billing.

When submitting a claim for KEYTRUDA, always verify coding requirements with the relevant payer. Coding requirements may vary by insurer or plan; please refer to the payer-specific policies to understand what may be covered.

Check with the relevant payer regarding guidance on which diagnoses they will recognize and the applicability of secondary codes. Health care professionals are solely responsible for selecting codes that appropriately reflect the patient’s diagnosis, the services rendered, and the applicable payers’ guidelines.

Providers should document the diagnosis with a sufficiently high degree of specificity based on the information available to enable the identification of the most appropriate code. Although CMS has said that an unspecified code may be appropriate in some cases, CMS has advised that you should always code with as much specificity as possible consistent with the clinical documentation.

Merck and its agents make no warranties concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. Merck cautions that payer-coding requirements vary and can frequently change, so it is important to regularly check with each payer or, where applicable, the Medicare Administrative Contractor as to payer-specific requirements. The use of this information does not guarantee payment or that any payment received will cover your costs.

Indication

KEYTRUDA is indicated for the treatment of patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) with disease progression on or after platinum-containing chemotherapy. This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials.

FDA-Approved Dosing

The FDA-approved dose of KEYTRUDA is 200 mg administered as an intravenous infusion over 30 minutes every 3 weeks until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression.

Possible relevant diagnosis codes for HNSCC

Learn more about each diagnosis code and descriptor by selecting from the series options below.

 

C00: Malignant Neoplasm of Lip4

The C00 series:

  • Excludes: malignant melanoma of lip, Merkel cell carcinoma of lip, other and unspecified malignant neoplasm of skin of lip
ICD-10-CM CODE DESCRIPTOR
C00.0 Malignant neoplasm of external upper lip
C00.1 Malignant neoplasm of external lower lip
C00.2 Malignant neoplasm of external lip, unspecified
C00.3 Malignant neoplasm of upper lip, inner aspect
C00.4 Malignant neoplasm of lower lip, inner aspect
C00.5 Malignant neoplasm of lip, unspecified, inner aspect
C00.6 Malignant neoplasm of commissure of lip, unspecified
C00.8 Malignant neoplasm of overlapping sites of lip
C00.9 Malignant neoplasm of lip, unspecified

C01: Malignant Neoplasm of Base of Tongue4

ICD-10-CM CODE DESCRIPTOR
C01 Malignant neoplasm of base of tongue

C02: Malignant Neoplasm of Other and Unspecified Parts of Tongue4

C02.0 excludes malignant neoplasm of dorsal surface of base of tongue; C02.4 excludes malignant neoplasm of tonsil not otherwise specified

ICD-10-CM CODE DESCRIPTOR
C02.0 Malignant neoplasm of dorsal surface of tongue
C02.1 Malignant neoplasm of border of tongue
C02.2 Malignant neoplasm of ventral surface of tongue
C02.3 Malignant neoplasm of anterior two-thirds of tongue, part unspecified
C02.4 Malignant neoplasm of lingual tonsil
C02.8 Malignant neoplasm of overlapping sites of tongue
C02.9 Malignant neoplasm of tongue, unspecified

C03: Malignant Neoplasm of Gum4

The C03 series:

  • Excludes: malignant neoplasm of alveolar (ridge) mucosa, malignant neoplasm of gingiva, malignant odontogenic neoplasms
ICD-10-CM CODE DESCRIPTOR
C03.0 Malignant neoplasm of upper gum
C03.1 Malignant neoplasm of lower gum
C03.9 Malignant neoplasm of gum, unspecified

C04: Malignant Neoplasm of Floor of Mouth4

ICD-10-CM CODE DESCRIPTOR
C04.0 Malignant neoplasm of anterior floor of mouth
C04.1 Malignant neoplasm of lateral floor of mouth
C04.8 Malignant neoplasm of overlapping sites of floor of mouth
C04.9 Malignant neoplasm of floor of mouth, unspecified

C05: Malignant Neoplasm of Palate4

The C05 series excludes Kaposi’s sarcoma of palate; C05.1 excludes malignant neoplasm of nasopharyngeal surface of soft palate

ICD-10-CM CODE DESCRIPTOR
C05.0 Malignant neoplasm of hard palate
C05.1 Malignant neoplasm of soft palate
C05.2 Malignant neoplasm of uvula
C05.8 Malignant neoplasm of overlapping sites of palate
C05.9 Malignant neoplasm of palate, unspecified

C06: Malignant Neoplasm of Other and Unspecified Parts of Mouth4

ICD-10-CM CODE DESCRIPTOR
C06.0 Malignant neoplasm of cheek mucosa
C06.1 Malignant neoplasm of vestibule of mouth
C06.2 Malignant neoplasm of retromolar area
C06.80 Malignant neoplasm of overlapping sites of unspecified parts of mouth
C06.89 Malignant neoplasm of overlapping sites of other parts of mouth
C06.9 Malignant neoplasm of mouth, unspecified

C09: Malignant Neoplasm of Tonsil4

The C09 series:

  • Excludes: malignant neoplasm of lingual tonsil, malignant neoplasm of pharyngeal tonsil
ICD-10-CM CODE DESCRIPTOR
C09.0 Malignant neoplasm of tonsillar fossa
C09.1 Malignant neoplasm of tonsillar pillar (anterior) (posterior)
C09.8 Malignant neoplasm of overlapping sites of tonsil
C09.9 Malignant neoplasm of tonsil, unspecified

C10: Malignant Neoplasm of Oropharynx4

The C10 series excludes malignant neoplasm of tonsil; C10.1 excludes malignant neoplasm of epiglottis (suprahyoid portion) not otherwise specified

ICD-10-CM CODE DESCRIPTOR
C10.0 Malignant neoplasm of vallecula
C10.1 Malignant neoplasm of anterior surface of epiglottis
C10.2 Malignant neoplasm of lateral wall of oropharynx
C10.3 Malignant neoplasm of posterior wall of oropharynx
C10.4 Malignant neoplasm of branchial cleft
C10.8 Malignant neoplasm of overlapping sites of oropharynx
C10.9 Malignant neoplasm of oropharynx, unspecified

C12: Malignant Neoplasm of Pyriform Sinus4

ICD-10-CM CODE DESCRIPTOR
C12 Malignant neoplasm of pyriform sinus

C13: Malignant Neoplasm of Hypopharynx4

The C13 series excludes malignant neoplasm of pyriform sinus; C13.1 excludes malignant neoplasm of aryepiglottic fold or interarytenoid fold, laryngeal aspect

ICD-10-CM CODE DESCRIPTOR
C13.0 Malignant neoplasm of postcricoid region
C13.1 Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect
C13.2 Malignant neoplasm of posterior wall of hypopharynx
C13.8 Malignant neoplasm of overlapping sites of hypopharynx
C13.9 Malignant neoplasm of hypopharynx, unspecified

C14: Malignant Neoplasm of Other and Ill-Defined Sites in the Lip, Oral Cavity, and Pharynx4

The C14 series excludes malignant neoplasm of oral cavity not otherwise specified; C14.8 excludes “book leaf” neoplasm (ventral surface of tongue and floor of mouth)

ICD-10-CM CODE DESCRIPTOR
C14.0 Malignant neoplasm of pharynx, unspecified
C14.2 Malignant neoplasm of Waldeyer’s ring
C14.8 Malignant neoplasm of overlapping sites of lip, oral cavity, and pharynx

C30: Malignant Neoplasm of Nasal Cavity and Middle Ear4

C30.0 excludes malignant melanoma of skin of nose, malignant neoplasm of nasal bone, malignant neoplasm of nose not otherwise specified, malignant neoplasm of olfactory bulb, malignant neoplasm of posterior margin of nasal septum and choana, malignant neoplasm of turbinates, other and unspecified malignant neoplasm of skin of nose; C30.1 excludes malignant melanoma of skin of (external) ear, malignant neoplasm of auricular canal (external), malignant neoplasm of bone of ear, malignant neoplasm of cartilage of ear, other and unspecified malignant neoplasm of skin of (external) ear

ICD-10-CM CODE DESCRIPTOR
C30.0 Malignant neoplasm of nasal cavity
C30.1 Malignant neoplasm of middle ear

C31: Malignant Neoplasm of Accessory Sinuses4

ICD-10-CM CODE DESCRIPTOR
C31.0 Malignant neoplasm of maxillary sinus
C31.1 Malignant neoplasm of ethmoidal sinus
C31.2 Malignant neoplasm of frontal sinus
C31.3 Malignant neoplasm of sphenoid sinus
C31.8 Malignant neoplasm of overlapping sites of accessory sinuses
C31.9 Malignant neoplasm of accessory sinus, unspecified

C32: Malignant Neoplasm of Larynx4

C32.1 excludes malignant neoplasm of anterior surface of epiglottis; malignant neoplasm of aryepiglottic fold or interarytenoid fold, hypopharyngeal aspect; malignant neoplasm of aryepiglottic fold or interarytenoid fold, marginal zone; malignant neoplasm of aryepiglottic fold or interarytenoid fold, not otherwise specified

ICD-10-CM CODE DESCRIPTOR
C32.0 Malignant neoplasm of glottis
C32.1 Malignant neoplasm of supraglottis
C32.2 Malignant neoplasm of subglottis
C32.3 Malignant neoplasm of laryngeal cartilage
C32.8 Malignant neoplasm of overlapping sites of larynx
C32.9 Malignant neoplasm of larynx, unspecified

C76.0: Malignant Neoplasm of Head, Face, and Neck (other and ill-defined sites)4

ICD-10-CM CODE DESCRIPTOR
C76.0 Malignant neoplasm of head, face, and neck