Oncology & Hematology Coding Alert

Question: What terms should I look for to be sure I choose the most appropriate code from the 141.x range?


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Answer: Try these tips to choose the most accurate tongue neoplasm code:

- 141.0 (Malignant neoplasm of tongue; base of tongue): The tongue base is posterior to the circumvallate papillae (big taste buds in the rear), which divide the tongue into the anterior two-thirds and the posterior one-third. Other terms for the tongue base include posterior tongue and tongue -root.-

- 141.1 (- dorsal surface of tongue): Dorsal refers to the tongue's top, anterior to the circumvallate papillae. For a midline, dorsal anterior two-thirds or fungiform papillae lesion, report 141.1.

- 141.2 (- tip and lateral border of tongue): Physicians may refer to the tip (the very front end) as the -apex.-

- 141.3 (- ventral surface of tongue): The frenulum, the plica fimbriata and the sublingual fold are all on the tongue's ventral surface (underside).

- 141.4 (- anterior two-thirds of tongue, part unspecified): If the physician treats a lesion in the anterior two-thirds (anterior to the circumvallate papillae) but does not specify where, you should report 141.4, whether it's the dorsal (top) or ventral (underside) surface.

- 141.5 (- junctional zone): If the surgeon documents cancer between the oral cavity and the oropharynx, he may be referring to the junctional zone.

- 141.6 (- lingual tonsil): The lingual tonsil lies in the posterior one-third of the tongue and is made up of bumpy follicles near the tongue's rear.

- 141.8 (- other sites of tongue): If the surgeon documents a tongue area not included in one of the more specific ICD-9 codes (such as cancer that spreads across several tongue sections), you should report 141.8.

- 141.9 (- tongue, unspecified): You should report 141.9 only if the physician doesn't specify which tongue section contains the neoplasm, and you aren't able to ask him for more information. Don't confuse this code with 141.8, which indicates that the physician specified the cancer site but ICD-9 doesn't include a code for it.

Protect yourself: If you-re in doubt about the correct code, ask the physician to clarify the anatomic area involved.

The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and past-president of the American Academy of Professional Coders National Advisory Board.