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The procedure described by CPT® Code 31395 is a pharyngolaryngectomy combined with a radical neck dissection (RND) and includes reconstruction. A pharyngolaryngectomy is a surgical operation that entails the removal of the larynx, which is the organ responsible for voice production, along with a segment of the pharynx, the part of the throat situated behind the mouth and nasal cavity. This procedure is primarily indicated for patients diagnosed with laryngeal cancers that have either invaded the pharynx or have metastasized to this area. In some cases, it may also be performed due to severe injuries to the throat or neck or other diseases that necessitate the excision of these structures, although such instances are less common. Prior to the pharyngolaryngectomy, a tracheostomy is typically performed to facilitate the administration of anesthesia and to ensure an airway is established. The surgical approach involves making a horizontal incision in the neck at the level of the thyroid cartilage, allowing the surgeon to raise subplatysmal flaps and expose the larynx for dissection. During the procedure, various anatomical structures, including the delphian node, thyroid gland, hyoid bone, and thyroid cartilage, are removed as part of the radical neck dissection. This dissection involves the excision of lymph node groups from levels I to V, as well as the removal of surrounding tissues such as the sternocleidomastoid muscle, internal jugular vein, and submandibular gland. The surgical technique also includes entering the larynx, which is dictated by the extent of the disease, and subsequently removing it along with the identified portion of the pharynx. After the excision, a tracheostoma is created to allow for breathing, with the trachea being externalized and sutured to the skin at the sternal notch. In contrast to CPT® Code 31390, where reconstruction is not performed, CPT® Code 31395 involves reconstructing the pharynx and larynx during the same surgical session. This reconstruction may utilize advancement flaps from remaining pharyngeal tissue or myocutaneous flaps from areas such as the chest, back, or forearm, ensuring that the surgical site is effectively closed and functional post-operation.
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The pharyngolaryngectomy with radical neck dissection and reconstruction, as described by CPT® Code 31395, is indicated for the following conditions:
The surgical procedure for CPT® Code 31395 involves several critical steps, which are detailed as follows:
After the completion of the pharyngolaryngectomy with radical neck dissection and reconstruction, patients typically require close monitoring in a postoperative setting. Expected recovery may involve managing the tracheostoma, ensuring proper airway maintenance, and monitoring for any signs of complications such as infection or bleeding. Patients may also need assistance with swallowing and speech rehabilitation, as the removal of the larynx significantly impacts these functions. Follow-up care is essential to assess the surgical site, manage any ongoing treatment for cancer, and address the patient's overall recovery process.
| Short Descr | RECONSTRUCT LARYNX & PHARYNX | Medium Descr | PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/RCNSTJ | Long Descr | Pharyngolaryngectomy, with radical neck dissection; with 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. | 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). | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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 | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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