Otolaryngology Coding Alert

Question: I am struggling with the following case, specifically whether to report the procedures separately. What is proper coding for the partial glossectomy and neck dissection?

The otolaryngologist examines a 35-year-old patient with a painful left tongue growth for the past four months and notes a 3.5 cm ulcerated lesion of the left lateral tongue and a 2.5 cm firm mass in the right mid-jugular region. After the doctor learns the path report indicates squamous cell carcinoma, they perform a partial glossectomy and a unilateral radical neck dissection.

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Answer: In this case, your otolaryngologist performed a partial glossectomy and unilateral radical neck dissection You should report 41135 (Glossectomy; partial, with unilateral radical neck dissection), which captures both procedures.

Sometimes, your surgeon might perform a bilateral neck dissection or lymphadenectomy. This procedure may be reported separately using 38720 (Cervical lymphadenectomy (complete)). However, you will face National Correct Coding Initiative (NCCI) edits if you are trying to report 38720 with 41135. The modifier indicator for this bundling edit is ‘1,’ which means you can override the edit by using a suitable modifier. You should append modifier XS (Separate structure …) or modifier 59 (Distinct procedural service), as appropriate and depending on payer preference, to 38720 to indicate that it was performed on a separate site.

Your surgeon might prefer to perform modified radical neck dissection (MRND) whenever possible to avoid jeopardizing spinal accessory nerve function, the jugular vein, and sternocleidomastoid muscles. MRND is more complex than radical dissection and should not be reported using 41135. Instead, report the appropriate glossectomy code without radical neck dissection with 38724 (Cervical lymphadenectomy (modified radical neck dissection)). You will need to append modifier 59 or modifier XU (Unusual non-overlapping service …) as appropriate in this scenario.

Example: Your surgeon performs a partial glossectomy and MRND. Proper coding is 38724 and either 41120-59 or 41120-XU, depending on payer preference. Note, you should append the modifier to 41120 rather than to 38724 because it is the lesser-valued procedure in this case.