ICD-10 C12
Billable / Specific HCC v28: 11Malignant neoplasm of pyriform sinus
About ICD-10-CM C12
ICD-10-CM code C12 represents Malignant neoplasm of pyriform sinus. This is a billable/specific code in the Neoplasms chapter (block C12). The 2026 edition of ICD-10-CM C12 became effective on October 1, 2025.
Coding Tips for C12
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C12 is a CMS-HCC v28 risk-adjustment code (category 11). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under C12. Per CMS ICD-10-CM Tabular 2026.
- Malignant neoplasm of pyriform fossa
Use Additional Code
When coding C12, also report these additional codes when applicable.
- 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)
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for C12
Local Coverage Determinations (LCDs) from CMS MACs that list C12 as a covered diagnosis.
Showing top 10 of 989 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C12.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with C12
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 97130 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 92608 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 97129 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 92607 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 96110 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 92524 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 92508 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 92597 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 92521 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
- 96105 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
Convert C12 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| C12 | 1481 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C12
Other codes in section C00-C14 (Malignant neoplasms of lip, oral cavity and pharynx).
ICD-10 C12, Billing FAQ
Is ICD-10 code C12 billable? +
Yes, C12 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to C12? +
ICD-10 C12 includes: Malignant neoplasm of pyriform fossa.
Does C12 affect Medicare Advantage HCC risk adjustment? +
Yes. C12 maps to CMS-HCC v28 category 11. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C12? +
Procedures frequently paired with C12 include: 97130, 92608, 97129, 92607, 96110.
What ICD-9 codes does C12 map to? +
Per CMS GEMs, C12 maps to ICD-9 codes: 1481. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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