Otolaryngology Coding Alert

Question: Documentation shows an otolaryngologist took a biopsy from the tongue's apex. The pathology report shows the neoplasm is malignant. What ICD-9 code should I use for a malignant lesion on the apex?

North Carolina Subscriber

Answer: Surgeons may refer to the tip of the tongue as the "apex." ENTs see most tongue cancers in this area, which includes the sides of the tongue and the tip. A primary malignancy comprising cells from the tip-of-the-tongue biopsy falls under 141.2 (Malignant neoplasm of tongue; tip and lateral border of tongue).

Beware: Your ICD-9 coding will change if the malignancy is not primary -- cancer that arises from the cells found where the surgeon biopsies the neoplasm, but secondary or in situ. For instance, if the cancer cells originated elsewhere -- such as the lip -- and spread to the tongue, you should code a secondary malignancy. You would code a pathology report that indicates that the tongue cancer is a secondary malignancy with the lip as the origin with ICD-9 code 198.89 (Secondary malignant neoplasm of other specified sites; other).

"In situ" describes malignancies confined to the site of origin without invasion of neighboring tissues. If a pathology report indicates the apex malignancy is CA (carcinoma) in situ, use 230.0 (Carcinoma in situ of digestive organs; lip, oral cavity, and pharynx).

Don't forget: You should assign a tongue biopsy code based on location. Because the apex is the front of the tongue, use the anterior biopsy code: 41100 (Biopsy of tongue; anterior two-thirds). If the otolaryngologist excises the lesion during a later session, check for wound closure. For a tongue excision without closure, use 41110 (Excision of lesion of tongue without closure). If the excision involves closure, select anterior tongue excision code 41112 (Excision of lesion of tongue with closure; anterior two-thirds).