Radiology Coding Alert

Question: A patient presents for a Computerized Tomography (CT) maxillofacial with an indicating diagnosis of a Warthin’s tumor. I cannot find this diagnosis in the ICD-10 manual. What diagnosis code should I apply?

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Answer: 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, you 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.

Your 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. Your 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 the physician specifies it as a parotid neoplasm, you 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).

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 to reach the correct diagnosis.