Otolaryngology Coding Alert

For this salivary gland disease, follow these Dx coding rules.

It’s fair to say that ICD-10 could have done a better job in documenting codes for the vast array of differentdiseases that invade the salivary glands. There are, in fact, numerous instances in which the ICD-10 index will not lead you to any existing code for a particular disease.

Let’s take a look at one particular code and see how to navigate the ICD-10 index to find the most accurate diagnosis code available.

Warthin’s Tumor

A Warthin’s tumor is, quite simply, a benign salivary gland tumor most often affecting the parotid gland. Its scientific name is “papillary cystadenoma lymphomatosum” — however, you’ll find that neither name can be found within the ICD-10 index.

In cases such as this, we can take a few different approaches in attempting to find the most appropriate ICD-10 code. The first option would be to utilize any and all keywords in the description that are indexable. In this case, our only option is indexing the keyword “tumor.” This will direct us toward the Table of Neoplasms à Neoplasm, unspecified behavior, by site. Factoring in our knowledge that Warthin’s tumors are inherently benign, we can conclude this is incorrect without going any further.

Our next option would be to take a look at the scientific name. While the full description cannot be found within the index, you can resort to indexing individual keywords within the description. When we search for “cystadenoma” in the ICD-10 index, we’re lead to Neoplasm, benign, by site. Based on our knowledge of Warthin’s tumors, this approach certainly seems to be the most accurate. Our search will then take us to the Table of Neoplasms à Benign neoplasm of the salivary glands. In the case of a Warthin’s tumor, unless it’s specified as a parotid neoplasm, we can’t make the assumption that the area affected is within the parotid region. The correct code for an unspecified Warthin’s tumor is D11.9 (Benign neoplasm of major salivary gland, unspecified).

Coding Correction: Use ICD-10 Index, Reach Correct Thyroid Dx

In the previous issue, we answered a reader question regarding the coding of a patient with diagnosed hyperthyroidism in addition to a single thyroid nodule. We suggested the use of code E05.20 (Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm), however the correct code would be E05.10 (Thyrotoxicosis with toxic single thyroid nodule without thyrotoxic crisis or storm).

Look out: The index will direct you to code E05.20 if you search via the term “nodule.” Use “hyperthyroidism” as the initial search term to reach the correct code.

Understanding how to find the diagnosis for a Warthin’s tumor using the ICD-10 index (among other resources) will leave you more qualified and prepared to handle scenarios where the index alone is simply not enough. In future issues, we will cover other examples of non-indexable diseases and symptoms of the ears, nose, and throat.