Guidance
The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Transoral carbon dioxide laser surgery for primary treatment of oropharyngeal malignancy, in March 2014.
Description
Malignancies in the oropharynx (which includes the tonsils, the base of the tongue and the soft palate) are usually squamous cell carcinomas originating in the epithelial cell lining. The incidence of these malignancies has increased significantly in younger patients, probably because of the increased prevalence of human papillomavirus infection. Presenting features include a persistent sore throat, a lesion in the mouth or throat, white or red patches that may be swollen or bleeding and pain in the ear. Patients tend to present with advanced or sometimes metastatic disease.
Patients with oropharyngeal cancers can be treated by surgery (using open or minimally invasive approaches for tumour resection and reconstruction), radiotherapy, chemotherapy, or a combination of these methods. Surgical resection may include neck dissection to remove lymph nodes. When the malignancy is considered to be unresectable, palliative chemotherapy and radiotherapy can be used.
Coding recommendations
E24.2 Endoscopic extirpation of lesion of pharynx NEC
Y08.2 Laser excision of lesion of organ NOC
However, as the oropharynx includes the tonsils, the back of the tongue and the soft palate, if the malignany involved one of these sites and the excision only involved one of these site than the OPCS-4 codes assigned will be different.