Pathology/Lab Coding Alert

Code ‘lesion excision’ based on purpose.

Coding for tongue specimens should be easy enough — but making a common error could cost you bundles. Let our experts illuminate the gray area called tongue “lesion excision” that could easily lead you astray.

Learn Pathology CPT^® Code Options

When your pathologist examines a tongue specimen, you have two distinct code choices for the service — and they pay radically different amounts (based on Medicare Physician Fee Schedule non-facility national amount, conversion factor 35.8043):

• 88305 — Level IV - Surgical pathology, gross and microscopic examination … Tongue, biopsy ($74.11)
• 88309 — Level VI - Surgical pathology, gross and microscopic examination … Tongue/tonsil -resection for tumor ($474.05)

You can see that choosing the wrong code could mean sacrificing $400 pay that your pathologist deserves.

Follow Tips for Best Procedure Code Choice

Here are some tips to help you decide which CPT^® code(s) to use when you’re reporting out a tongue specimen case.

Tip 1 - biopsy: A biopsy is a piece of tissue removed only for diagnostic purposes, not to treat a tumor or other condition by removing all diseased tissue. The surgical report should identify the specimen as a tongue biopsy, and a surgical procedure such as 41100 (Biopsy of tongue; anterior two-thirds) or 41105 (... posterior one-third) would certainly indicate that you have an 88305 specimen, regardless of the pathologist’s final diagnosis.

Tip 2 - resection: If the surgeon surgically removes all or part of the tongue, you might see the term “glossectomy” in the documentation, with possible surgical codes 41120 (Glossectomy; less than one-half tongue), 41130 (…hemiglossectomy), or 41140 (…complete or total, with or without tracheostomy, without radical neck dissection).

“These surgical procedures are almost always for tumor, which means that the appropriate pathology glossectomy specimen code would be 88309,” says R.M. Stainton Jr., MD, president of Doctors Anatomic Pathology Services in Jonesboro, Ark.

Tip 3 - lesion excision: What if the surgeon submits a specimen called a tongue “lesion excision” from one of the surgical procedures 41110-41113 (Excision of lesion of tongue …) — is that an 88305 or 88309 specimen? The answer depends on whether the surgeon indicates that the lesion is suspicious for cancer.

“If the pathologist examines an excised tongue lesion for cancer, you should code the 88309 service,” Stainton says. That’s true regardless of the specimen size or whether the final diagnosis confirms cancer.

Tip 4 - other specimens: The surgeon may submit other specimens with the tongue tissue. For instance, you might receive multiple separately-identified biopsies, which would warrant multiple units of 88305. Or the surgeon might also separately identify and submit additional tissue such as a salivary gland. In addition to the tongue specimen, you can separately report a salivary gland biopsy (88305 … Salivary gland, biopsy…) or a complete salivary gland specimen (88307, Level V - Surgical pathology, gross and microscopic examination,… Salivary gland…).

Focus ICD-10 Coding, Too

When a tongue pathology report returns with a statement of malignancy, you’ll need some excellent anatomical knowledge to select the proper diagnosis code.

“The site of the cancer should coordinate with the gross pathology specimen description,” says Barry Shipman, DMD, clinical professor, University of Florida School of Dentistry, Hialeah Dental Center. Unfortunately, the pathologist might not always use the specific terms that are in ICD-10 code descriptors. We’ve got some tips so you can equate your pathologist’s documentation with the most accurate diagnosis code.

• C01 — Malignant neoplasm of base of the tongue
  The tongue is divided into the anterior two-thirds and the posterior one-third by the circumvallate papillae, which are bit taste buds on the back of the tongue occurring in a V shape. Behind (or posterior to) the circumvallate papillae is the base of the tongue. The circumvallate papillae are important guidelines when determining where the tongue specimen originates. Therefore, if the pathology report documents any lesions on the posterior tongue, the root of the tongue, or behind the circumvallate papillae, he is most likely referring to the base of the tongue.
• C02.0 — … of dorsal surface of tongue
  This refers to the top of the tongue anterior to (or in front of) the circumvallate papillae. If the report documents a lesion to the midline of the tongue, the dorsal anterior two-thirds, or the fungiform papillae, you should report C02.0.
• C02.1 — … of border of tongue
  You will find most tongue cancers in this area, which includes the sides of the tongue and the tip. The pathology report may refer to the tip as the apex.
• C02.2 — … of ventral surface of tongue
  The report may refer to the ventral surface when the excision involves underside of the tongue. The documentation might also mention the frenulum, the plica fimbriata, or the sublingual fold, because these sites are all on the ventral surface.
• C02.3 … of anterior two-thirds of tongue, part unspecified

If the excised lesion is in the anterior two-thirds of the tongue (anterior to the circumvallate papillae) without further specificity, you should report this code.

Tip: The anterior two-thirds does not refer to the top of the tongue only. The ventral tongue is always considered part of the anterior two-thirds. Therefore, if the documentation refers to the anterior two-thirds but you don’t know whether it was the ventral or dorsal surface, you can still report C02.3.

• C02.8 … of overlapping sites of tongue 
  This includes cancer that spreads across several sections of the tongue, or cancer between the oral cavity and the oropharynx, which the report may refer to as the “junctional zone” of the tongue. 
• C02.4 — … of lingual tonsil
  The lingual tonsil lies in the posterior one-third of the tongue. This area is made up of bumpy follicles near the back of the tongue
• C02.9 — … unspecified
  Use this code if the pathology report doesn’t document the lesion location on the tongue.