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The procedure described by CPT® Code 31367 refers to a subtotal supraglottic laryngectomy (SGL) performed without a radical neck dissection (RND). This surgical intervention is primarily indicated for the treatment of cancer that originates from specific areas of the larynx, including the epiglottis, aryepiglottic folds, and false vocal cords. The goal of the subtotal supraglottic laryngectomy is to excise the cancerous tissue while preserving essential laryngeal functions, which include airway protection, respiration, and the ability to produce sound (phonation). Prior to the laryngectomy, a tracheostomy is performed to secure the airway, ensuring that the incision for the tracheostomy remains distinct from the incision made for the laryngectomy itself. The surgical approach involves making a horizontal incision in the neck at the level of the thyroid cartilage, followed by the careful dissection of surrounding tissues to access the larynx. This procedure is critical for patients with localized laryngeal cancer, as it aims to remove the tumor while maintaining as much of the laryngeal structure and function as possible.
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The subtotal supraglottic laryngectomy (CPT® Code 31367) is indicated for patients diagnosed with cancer affecting specific regions of the larynx. The following conditions are typically associated with the need for this procedure:
The subtotal supraglottic laryngectomy involves several critical steps to ensure the effective removal of cancerous tissue while preserving vital laryngeal functions. The procedure begins with the performance of a tracheostomy, which is essential for maintaining the airway during surgery. Care is taken to ensure that the tracheostomy incision is separate from the incision made for the laryngectomy. Following this, a horizontal incision is made in the skin of the neck at the level of the thyroid cartilage. This incision allows access to the underlying structures.
Next, subplatysmal flaps are raised to expose the deeper tissues. The suprahyoid muscles are carefully released from the hyoid bone, and the infrahyoid muscles are divided to facilitate access to the larynx. The greater cornu of the hyoid bone is skeletonized bilaterally, with particular attention paid to preserving the hypoglossal nerves, which are crucial for tongue movement and function.
Once the necessary structures are accessed, the thyroid cartilage is incised in a manner that preserves the true vocal cords. The surgeon then enters the pharynx through either the vallecula or the contralateral pyriform sinus. An incision is made in the mucosa anterior to the arytenoid, followed by a perpendicular incision across the aryepiglottic fold, extending to the level of the ventricle. This incision is then turned horizontally, allowing the larynx to be opened in a book-like fashion.
After exposing the larynx, the portion containing the tumor is excised. The surgical wound is subsequently closed by reapproximating the thyroid cartilage to the tongue base, ensuring that the anatomical structures are restored as closely as possible to their original position. Drains are placed to manage any postoperative fluid accumulation, and the skin incisions are closed to complete the procedure.
Post-procedure care following a subtotal supraglottic laryngectomy includes monitoring for complications such as bleeding, infection, and airway obstruction. Patients may require assistance with breathing and swallowing as they recover from the surgery. The expected recovery period can vary, but patients are typically advised to follow up with their healthcare provider for ongoing assessment of laryngeal function and to address any concerns related to speech and swallowing. Rehabilitation may be necessary to help patients adapt to changes in their voice and to ensure proper healing of the surgical site.
| Short Descr | PARTIAL REMOVAL OF LARYNX | Medium Descr | LARYNGECTOMY STOT SUPRAGLOTTIC W/O RAD NECK DSJ | Long Descr | Laryngectomy; subtotal supraglottic, without radical neck dissection | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 42 - Other OR therapeutic procedures on respiratory system |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition |
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| Pre-1990 | Added | Code added. |
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