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The procedure described by CPT® Code 31390 is a pharyngolaryngectomy with radical neck dissection (RND) performed without reconstruction. This surgical intervention involves the removal of the larynx, which is the voice box, along with a portion of the pharynx, the part of the throat behind the mouth and nasal cavity. The primary indication for this procedure is typically laryngeal cancer that has either invaded the pharynx or has metastasized to this area. In some cases, severe injuries to the throat or neck, or other diseases not related to cancer, may also necessitate the excision of both the pharynx and larynx. Before the pharyngolaryngectomy is performed, a tracheostomy is established to facilitate anesthesia administration and ensure the patient's airway is secure during the procedure. The surgical approach begins with a horizontal incision in the neck at the level of the thyroid cartilage, allowing access to the larynx. The surrounding tissues are carefully dissected to expose the larynx, which is then removed along with various structures in the neck, including lymph nodes and muscles, as part of the radical neck dissection. The procedure concludes with the creation of a tracheostoma, which is a permanent opening in the neck that allows the patient to breathe directly through the trachea. It is important to note that in this specific code, no reconstruction of the pharynx and larynx is performed during the same surgical session, distinguishing it from related procedures where reconstruction may occur. This comprehensive approach is critical for managing advanced laryngeal cancers and ensuring the best possible outcomes for patients undergoing this complex surgery.
© Copyright 2025 Coding Ahead. All rights reserved.
The pharyngolaryngectomy with radical neck dissection (CPT® Code 31390) is indicated for the following conditions:
The procedure for CPT® Code 31390 involves several critical steps, which are detailed as follows:
After the pharyngolaryngectomy with radical neck dissection, patients will require careful monitoring and post-operative care. The creation of a tracheostoma necessitates specific care to ensure the stoma remains patent and free from infection. Patients may experience significant changes in their ability to speak and swallow, and they will need to be educated on how to manage their new airway. Follow-up appointments will be essential to monitor healing and to assess any need for further interventions, including potential staged reconstruction procedures at a later date if indicated. Pain management and nutritional support will also be critical components of the post-operative care plan.
| Short Descr | REMOVAL OF LARYNX & PHARYNX | Medium Descr | PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/O RCNSTJ | Long Descr | Pharyngolaryngectomy, with radical neck dissection; without reconstruction | 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 | 33 - Other OR therapeutic procedures on nose, mouth and pharynx |
| 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. | 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). | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | LT | Left side (used to identify procedures performed on the left side of the body) |
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| Pre-1990 | Added | Code added. |
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