Otolaryngology Coding Alert

CPT 2002 distinguishes more than a dozen glossectomy-related codes from one another, based on the location and size of the portion of the tongue that was removed and whether other procedures were performed during the glossectomy.
 
Glossectomy-related procedures are performed most often on patients with lingual cancers, such as a squamous cell carcinoma of the oral tongue, says Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J., and a member of CPT's Editorial Panel and Executive Committee.
 
Note: The "oral tongue" includes the anterior two-thirds of the tongue; the "base of the tongue" includes the posterior one-third of the tongue.
 
Eisenberg breaks glossectomy-related codes into two groups, the first group covering diagnostic procedures (such as biopsies and lesion excisions) and the second group covering glossectomy procedures themselves.
Diagnostic Procedures
Biopsy Codes. The portion of the tongue on which the procedure is performed distinguishes the biopsy codes from one another:

  41100 biopsy of tongue; anterior two-thirds
  41105 ... posterior one-third.
Lesion Excision Codes. The portion of the tongue on which the procedure is performed, as well as the need for closure of the wound, distinguishes the four lesion excision codes from one another:

41110 excision of lesion of tongue without closure
41112 excision of lesion of tongue with closure; anterior two-thirds
41113 ... posterior one-third
CPT 41115 excision of lingual frenum (frenectomy).
Note: Code 41115 describes a frenectomy, in which a part or all of the midline sheath of tissue attached to the base of the tongue (known as the lingual frenum) is excised.
Glossectomy Procedures
When a significant portion of the tongue is removed, the procedure should be reported using one of eight glossectomy codes. These codes vary according to 1) the amount of tongue that is removed, 2) whether a neck dissection was performed, 3) whether a resection of the floor of the mouth was also performed and 4) whether the mandible was resected.
 
Glossectomy procedure codes include:

41120 glossectomy; less than one-half tongue
41130 hemiglossectomy
41135 partial, with unilateral radical neck dissection
41140 complete or total, with or without tracheostomy, without radical neck dissection
41145 complete or total, with or without tracheostomy, with unilateral radical neck dissection
41150 composite procedure with resection floor of mouth and mandibular resection, without radical neck dissection
41153 composite procedure with resection floor of mouth, with suprahyoid neck dissection
41155 composite procedure with resection floor of mouth, mandibular resection, and radical neck dissection (commando type).
Note: Any reconstruction that is required, such as bone, skin or mucosal grafts, may be reported separately.

Bundling Issues
Bilateral Radical Neck Dissections. Codes 41135 and 41145 make specific reference to "unilateral" neck dissections. Sometimes, however, the otolaryngologist will perform a bilateral neck dissection or lymphadenectomy. This [...]