Otolaryngology Coding Alert

You can pin down the right neoplasm ICD-9 code with a few quick tips

Do you know your ventral surface from your lateral border? Your tongue cancer coding depends on it.

The ICD-9 -malignant neoplasm of tongue- tabular list is separated into nine different tongue cancer codes. If you want to find the right code, you-ll have to determine where the physician diagnosed or treated the patient's cancer. Unfortunately, the otolaryngologist won't always use the terms that are in ICD-9. We-ve got some tips so you can equate your ENT's documentation with the most accurate diagnosis code.

We-ve broken down the tongue cancer section of ICD-9, code-by-code, along with advice from seasoned otolaryngologists:

- 141.0--Malignant neoplasm of tongue; base of tongue. -The tongue is divided into the anterior two-thirds and the posterior one-third by the circumvallate papillae,- says Seth M. Goldberg, MD, an otolaryngologist in Rockville, Md. Behind (or posterior to) the circumvallate papillae is the base of the tongue.

The circumvallate papillae are important guidelines when determining which part of the tongue the surgeon treated. -These are the big taste buds on the back of the tongue, which are in the shape of a -V,- - says Jason G. Newman, MD, assistant professor in the Department of Otorhinolaryngology, Head and Neck Surgery at the University of Pennsylvania Hospital. 

Therefore, if the surgeon documents any lesions on the posterior tongue, the -root- of the tongue, or behind the circumvallate papillae, he is most likely referring to the base of the tongue. 
 
- 141.1--Malignant neoplasm of tongue; dorsal surface of tongue. This refers to the top of the tongue anterior to (or in front of) the circumvallate papillae. If the surgeon documents a lesion to the midline of the tongue, the dorsal anterior two-thirds, or the fungiform papillae, you should report 141.1.

- 141.2--Malignant neoplasm of tongue; tip and lateral border of tongue. ENTs see most tongue cancers in this area, which includes the sides of the tongue and the tip. Surgeons may refer to the tip as the -apex.-

- 141.3--Malignant neoplasm of tongue; ventral surface of tongue. Surgeons will refer to the ventral surface when they treat the underside of the tongue. They might also document attention to the frenulum, the plica fimbriata, or the sublingual fold, because these sites are all on the ventral surface.

- 141.4--Malignant neoplasm of tongue; anterior two-thirds of tongue, part unspecified. If the surgeon treats a lesion in the anterior two-thirds of the tongue (anterior to the circumvallate papillae) but does not specify where, you should report this code.

Tip: The -anterior two-thirds- does not refer to the top of the tongue only. -The ventral tongue is always considered part of the anterior two-thirds,- Goldberg says. Therefore, if your surgeon simply documents that he focused on the anterior two-thirds but you don't know whether it was the ventral or dorsal surface, you can still report 141.4.

- 141.5--Malignant neoplasm of tongue; junctional zone. If the surgeon documents a cancer that is between the oral cavity and the oropharynx, he may be referring to the junctional zone, Newman says.

- 141.6--Malignant neoplasm of tongue; lingual tonsil. The lingual tonsil lies in the posterior one-third of the tongue, Goldberg says. This area is made up of bumpy follicles near the back of the tongue.

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

- 141.9--Malignant neoplasm of tongue; tongue, unspecified. You should report 141.9 only if the physician doesn't specify which section of the tongue contains the neoplasm and you aren't able to ask him for more information. You should not confuse this code with 141.8, because 141.8 indicates that the ENT specified the cancer site but ICD-9 simply didn't include a code for it.