Otolaryngology Coding Alert

Question: The otolaryngologist excises a tongue lesion on the lateral border of the posterior third of the tongue and closes the defect with sutures because the lesion was located deep in the submucosal tissue. We billed 41112 but the claim was denied. How should this surgery be coded?

Nebraska Subscriber

Answer: Because the excised lesion was in the posterior one-third of the tongue and your surgeon performed closure of the surgical site, you should report 41113 (Excision of lesion of tongue with closure; posterior one-third). Had the otolaryngologist excised a lesion from the anterior two-thirds of the tongue, then would it have been appropriate to use 41112 (Excision of lesion of tongue with closure; anterior two-thirds).

Beware: If you failed to note the closure and instead reported 41110, your error would cost the otolaryngologist $135.55 of legitimate pay (based on the national non-facility amount of $235.85 for 41110 and $371.40 for 41113).