Oncology & Hematology Coding Alert

You can’t think leukoplakia for K13.3; don’t forget additional codes that apply.

You may commonly submit claims for oral patches. Not every oral patch is a malignancy. Your physician may document ‘hairy leukoplakia’ leaving you confused if this is a malignancy. Moreover, your physician may decide to biopsy some patches and add to your confusion. Here is how you can earn for this diagnosis and how you confirm it.

Focus on K13.3 for Hairy Leukoplakia

When your physician identifies the diagnosis as oral hairy leukoplakia, you should remember that there is a specific ICD-10-CM code to report the condition. You should report this diagnosis with the ICD-10 code, K13.3 (Hairy leukoplakia). The additional notes for this code mention that you use the same ICD-10-CM code when your clinician identifies the patient’s condition as “epithelial disturbances of tongue.”

Check These Additional Codes: When reporting any conditions that are reported under the parent code K13.-, you are also supposed to report additional codes. You may select form the following additional codes:

• Alcohol abuse and dependence (F10.-);
• Exposure to environmental tobacco smoke (Z77.22);
• History of tobacco use (Z87.891);
• Occupational exposure to environmental tobacco smoke (Z57.31);
• Tobacco dependence (F17.-) or tobacco use (Z72.0).

Caveat:  Restrict the code K13.3 for only hairy leukoplakia. You cannot use this code for other diagnosis like leukoplakia or nicotina palate.

You should report a diagnosis of leukoplakia of the oral cavity with K13.21 (Leukoplakia of oral mucosa, including tongue).

For leukokeratosis nicotina palati or smoker’s palate, you will report the ICD-10 code, K13.24 (Leukokeratosis nicotina palati).

According to Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Managing Director of Pinnacle Enterprise Risk Consulting Services (“PERCS”), a division of Pinnacle Healthcare Consulting, follwong are the differences in these conditions:

• K13.3 is a condition characterised by irregular white patches on the side of the tongue and occasionally elsewhere on the tongue or in the mouth. As a form of leukoplakia, it often arises in response to chronic irritation.
• K13.21 (Leukoplakia of oral mucosa, including tongue) are predominantly white lesion of the oral mucosa that cannot be characterized as any other definable lesion. Some clinicians may refer to any oral white patch as “leukoplakia.”
• K13.24 (Leukokeratosis nicotina palati) nicotine stomatitis or “smokers’ tongue” is a homogeneous leukoplakia with evenly distributed pin-point hemispherical depressions.

Go Beyond Examination for Oral Patches

Check the clinical documentation for history, signs and symptoms, results from tests and histological tests that your physician used to arrive at a diagnosis of oral hairy leukoplakia.

Example:  Your physician reviews a 35-year-old female patient with complaints of white patches on the tongue that have been occurring periodically for many months now. She complains that she has been noticing these patches occurring and resolving spontaneously and she had no discomfort from them although they would appear to be quite unsightly. She also says that the lesions are now becoming slightly painful but she doesn’t have any other signs and symptoms such as altered taste. The patient was on chemotherapy for breast cancer a few months ago. She has no history of alcohol use but used to smoke two cigarette packs a day prior to treatment for breast cancer.

Upon examination, your clinician notes the presence of two lesions on the lateral border of the tongue. The lesions have a folded appearance with one of the lesions bearing a slightly ulcerated surface while your clinician notes that the surrounding tissue appears to be normal. Based on clinical appearance, your clinician suspects a diagnosis of oral hairy leukoplakia. Since one of the lesions had an ulcerated appearance, your surgeon opts to perform a biopsy and sends the sample for histological studies.

Based on history, signs and symptoms, observations of clinical examination and histological studies, » your clinician arrives at the diagnosis of oral hairy leukoplakia.

What to report: You report the biopsy that your clinician performed with 41105 (Biopsy of tongue; posterior one-third). You report the diagnosis of hairy leukoplakia with K13.3. Since the patient has had a history of tobacco use in the past, you will need to report this with an additional code using Z87.891.