KEYTRUDA FOR METASTATIC OR UNRESECTABLE,
RECURRENT HNSCC

The following codes as of September 2023 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, in combination with platinum and fluorouracil (FU), is indicated for the first-line treatment of patients with metastatic or with unresectable, recurrent head and neck squamous cell carcinoma (HNSCC).

KEYTRUDA, as a single agent, is indicated for the first-line treatment of patients with metastatic or with unresectable, recurrent HNSCC whose tumors express programmed death ligand 1 (PD-L1) [combined positive score (CPS) ≥1] as determined by an FDA-approved test.

KEYTRUDA, as a single agent, is indicated for the treatment of patients with recurrent or metastatic HNSCC with disease progression on or after platinum-containing chemotherapy.

FDA-Approved Dosing

The FDA-approved dose of KEYTRUDA is either 200 mg administered after dilution as an intravenous infusion over 30 minutes every 3 weeks or 400 mg administered after dilution as an intravenous infusion over 30 minutes every 6 weeks, until disease progression, unacceptable toxicity, or up to 24 months. When administering KEYTRUDA in combination with chemotherapy, administer KEYTRUDA prior to chemotherapy when given on the same day. Refer to the Prescribing Information for the chemotherapy agents administered in combination with KEYTRUDA for recommended dosing information, as appropriate.

See full Prescribing Information for preparation and administration instructions and dosage modifications for adverse reactions.

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
  • Malignant neoplasm of lipstick area of upper lip
  • Malignant neoplasm of upper lip not otherwise specified
  • Malignant neoplasm of vermilion border of upper lip
C00.1 Malignant neoplasm of external lower lip
  • Malignant neoplasm of lower lip not otherwise specified
  • Malignant neoplasm of lipstick area of lower lip
  • Malignant neoplasm of vermilion border of lower lip
C00.2 Malignant neoplasm of external lip, unspecified
  • Malignant neoplasm of vermilion border of lip not otherwise specified
C00.3 Malignant neoplasm of upper lip, inner aspect
  • Malignant neoplasm of buccal aspect of upper lip
  • Malignant neoplasm of frenulum of upper lip
  • Malignant neoplasm of mucosa of upper lip
  • Malignant neoplasm of oral aspect of upper lip
C00.4 Malignant neoplasm of lower lip, inner aspect
  • Malignant neoplasm of buccal aspect of lower lip
  • Malignant neoplasm of frenulum of lower lip
  • Malignant neoplasm of mucosa of lower lip
  • Malignant neoplasm of oral aspect of lower lip
C00.5 Malignant neoplasm of lip, unspecified, inner aspect
  • Malignant neoplasm of buccal aspect of lip, unspecified
  • Malignant neoplasm of frenulum of lip, unspecified
  • Malignant neoplasm of mucosa of lip, unspecified
  • Malignant neoplasm of oral aspect of lip, unspecified
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
  • Malignant neoplasm of dorsal surface of base of tongue
  • Malignant neoplasm of fixed part of tongue not otherwise specified
  • Malignant neoplasm of posterior third of tongue

C02: Malignant Neoplasm of Other and Unspecified Parts of Tongue4

The 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
  • Malignant neoplasm of anterior two-thirds of tongue, dorsal surface
  • Excludes: malignant neoplasm of dorsal surface of base of tongue (C01)
C02.1 Malignant neoplasm of border of tongue
  • Malignant neoplasm of tip of tongue
C02.2 Malignant neoplasm of ventral surface of tongue
  • Malignant neoplasm of anterior two-thirds of tongue, ventral surface
  • Malignant neoplasm of frenulum linguae
C02.3 Malignant neoplasm of anterior two-thirds of tongue, part unspecified
  • Malignant neoplasm of middle third of tongue not otherwise specified
  • Malignant neoplasm of mobile part of tongue not otherwise specified
C02.4 Malignant neoplasm of lingual tonsil
  • Excludes: malignant neoplasm of tonsil not otherwise specified (C09.9)
C02.8 Malignant neoplasm of overlapping sites of tongue
  • Malignant neoplasm of two or more contiguous sites of tongue
C02.9 Malignant neoplasm of tongue, unspecified

C03: Malignant Neoplasm of Gum4

The C03 series:

  • Excludes: 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
  • Malignant neoplasm of anterior to the premolar-canine junction
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
  • Excludes: malignant neoplasm of nasopharyngeal surface of soft palate (C11.3)
C05.2 Malignant neoplasm of uvula
C05.8 Malignant neoplasm of overlapping sites of palate
C05.9 Malignant neoplasm of palate, unspecified
  • Malignant neoplasm of roof of mouth

C06: Malignant Neoplasm of Other and Unspecified Parts of Mouth4

ICD-10-CM CODE DESCRIPTOR
C06.0 Malignant neoplasm of cheek mucosa
  • Malignant neoplasm of buccal mucosa not otherwise specified
  • Malignant neoplasm of internal cheek
C06.1 Malignant neoplasm of vestibule of mouth
  • Malignant neoplasm of buccal sulcus (upper) (lower)
  • Malignant neoplasm of labial sulcus (upper) (lower)
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
  • "Book leaf" neoplasm [ventrial surface of tongue and floor of mouth]
C06.9 Malignant neoplasm of mouth, unspecified
  • Malignant neoplasm of minor salivary gland, unspecified site
  • Malignant neoplasm of oral cavity not otherwise specified

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
  • Malignant neoplasm of tonsil not otherwise specified
  • Malignant neoplasm of faucial tonsils
  • Malignant neoplasm of palatine tonsils

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
  • Malignant neoplasm of epiglottis, free border [margin]
  • Malignant neoplasm of glossoepiglottic fold(s)
  • Excludes: malignant neoplasm of epiglottis (suprahyoid portion) not otherwise specified (C32.1)
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
  • Malignant neoplasm of branchial cyst [site of neoplasm]
C10.8 Malignant neoplasm of overlapping sites of oropharynx
  • Malignant neoplasm of junctional region 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
  • Malignant neoplasm of pyriform fossa

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
  • Malignant neoplasm of aryepiglottic fold, marginal zone
  • Malignant neoplasm of aryepiglottic fold not otherwise specified
  • Malignant neoplasm of interarytenoid fold, marginal zone
  • Malignant neoplasm of interarytenoid fold not otherwise specified
  • Excludes: malignant neoplasm of aryepiglottic fold or interarytenoid fold, laryngeal aspect (C32.1)
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
  • Malignant neoplasm of hypopharyngeal wall not otherwise specified

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
  • Primary malignant neoplasm of two or more contiguous sites of lip, oral cavity, and pharynx
  • Excludes: "book leaf" neoplasm [ventral surface of tongue and floor of mouth] (C06.89)

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 (meatus), 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
  • Malignant neoplasm of cartilage of nose
  • Malignant neoplasm of nasal concha
  • Malignant neoplasm of internal nose
  • Malignant neoplasm of septum of nose
  • Malignant neoplasm of vestibule of nose
  • Excludes: malignant neoplasm of nasal bone (C41.0)
  • Excludes: malignant neoplasm of nose not otherwise specified (C76.0)
  • Excludes: malignant neoplasm of olfactory bulb (C72.2-)
  • Excludes: malignant neoplasm of posterior margin of nasal septum and choana (C11.3)
  • Excludes: malignant melanoma of skin of nose (C43.31)
  • Excludes: malignant neoplasm of turbinates (C41.0)
  • Excludes: other and unspecified malignant neoplasm of skin of nose (C44.301, C44.311, C44.321, C44.391)
C30.1 Malignant neoplasm of middle ear
  • Malignant neoplasm of antrum tympanicum
  • Malignant neoplasm of auditory tube
  • Malignant neoplasm of eustachian tube
  • Malignant neoplasm of inner ear
  • Malignant neoplasm of mastoid air cells
  • Malignant neoplasm of tympanic cavity
  • Excludes: malignant neoplasm of auricular canal (external) (C43.2-, C44.2-)
  • Excludes: malignant neoplasm of bone of ear (meatus) (C41.0)
  • Excludes: malignant neoplasm of cartilage of ear (C49.0)
  • Excludes: malignant melanoma of skin of (external) ear (C43.2-)
  • Excludes: other and unspecified malignant neoplasm of skin of (external) ear (C44.2-)

C31: Malignant Neoplasm of Accessory Sinuses4

ICD-10-CM CODE DESCRIPTOR
C31.0 Malignant neoplasm of maxillary sinus
  • Malignant neoplasm of antrum (Highmore) (maxillary)
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 sinuses, 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
  • Malignant neoplasm of intrinsic larynx
  • Malignant neoplasm of laryngeal commissure (anterior) (posterior)
  • Malignant neoplasm of vocal cord (true) not otherwise specified
C32.1 Malignant neoplasm of supraglottis
  • Malignant neoplasm of aryepiglottic fold or interarytenoid fold, laryngeal aspect
  • Malignant neoplasm of epiglottis (suprahyoid portion) not otherwise specified
  • Malignant neoplasm of extrinsic larynx
  • Malignant neoplasm of false vocal cord
  • Malignant neoplasm of posterior (laryngeal) surface of epiglottis
  • Malignant neoplasm of ventricular bands
  • Excludes: malignant neoplasm of anterior surface of epiglottis (C10.1)
  • Excludes: malignant neoplasm of aryepiglottic fold or interarytenoid fold, hypopharyngeal aspect (C13.1)
  • Excludes: malignant neoplasm of aryepiglottic fold or interarytenoid fold, marginal zone (C13.1)
  • Excludes: malignant neoplasm of aryepiglottic fold or interarytenoid fold not otherwise specified (C13.1)
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

The C76 series excludes malignant neoplasm of female genitourinary tract not otherwise specified (NOS); malignant neoplasm of male genitourinary tract NOS; malignant neoplasm of lymphoid, hematopoietic, and related tissue; malignant neoplasm of skin; and malignant neoplasm of unspecified site NOS

ICD-10-CM CODE DESCRIPTOR
C76.0 Malignant neoplasm of head, face, and neck
  • Malignant neoplasm of cheek not otherwise specified
  • Malignant neoplasm of nose not otherwise specified