2025 ICD-10-CM code K12.31
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the digestive system - Diseases of oral cavity and salivary glands Diseases of the digestive system Feed
Oral mucositis (ulcerative) caused by antineoplastic therapy.
Modifiers are not applicable to ICD-10-CM codes.
Medical necessity for coding K12.31 is established by the presence of ulcerative oral mucositis as a direct consequence of antineoplastic therapy.Documentation must support the causal relationship between the chemotherapy and the development of the mucositis.
The clinical responsibility lies with the oncologist managing the cancer treatment and any medical professionals addressing the oral mucositis, such as dentists or oral surgeons, who may provide supportive care and manage complications.
- Diseases of the digestive system
- K00-K95 (Diseases of the digestive system) > K00-K14 (Diseases of oral cavity and salivary glands)
In simple words: This code describes painful sores and ulcers inside the mouth caused by cancer treatment medications (chemotherapy).These sores make eating and drinking difficult.
K12.31, Oral mucositis (ulcerative) due to antineoplastic therapy, is an ICD-10-CM code that classifies ulcerative inflammation of the oral mucosa as a consequence of cancer treatment using antineoplastic drugs.This condition is characterized by painful sores and ulcers in the mouth, hindering oral intake and potentially leading to complications such as dehydration, malnutrition, and infection.Additional codes may be necessary to specify the type of antineoplastic drug and any related adverse effects.This code should be used in conjunction with codes for the underlying cancer diagnosis and any other relevant complications.
Example 1: A 60-year-old patient receiving chemotherapy for lung cancer develops severe oral mucositis (ulcerative) requiring pain medication and dietary modifications.K12.31 is used to code the oral mucositis., A 45-year-old patient undergoing head and neck radiation therapy experiences painful oral mucositis, impacting their ability to eat and swallow.K12.31 is used alongside codes for the radiation therapy and any resulting complications., A 70-year-old patient on a high-dose chemotherapy regimen prior to a stem cell transplant develops severe ulcerative oral mucositis requiring hospitalization and intravenous nutrition. K12.31 is used, along with codes for the underlying condition and the supportive care provided.
Detailed clinical notes describing the onset, severity, and treatment of oral mucositis.Documentation should include the type and dosage of antineoplastic medications, the presence of ulcers, and any pain management strategies employed.If hospitalization or nutritional support was provided, this should also be documented.
** K12.31 should be used only when the oral mucositis is clearly caused by antineoplastic therapy.If the mucositis is due to other causes, such as radiation or other medications, the appropriate code should be used instead.Always ensure proper documentation to support the diagnosis.
- Revenue Code: Revenue codes will vary depending on the specific services provided and the payer.
- RVU: RVUs are not applicable to ICD-10 codes.Reimbursement is determined by the procedures and services provided, which would be coded using CPT or HCPCS codes.
- Global Days: Not applicable to this diagnostic code.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Not applicable to ICD-10 codes.
- Specialties:Oncology, Hematology, Dentistry, Oral and Maxillofacial Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, Ambulatory Surgical Center