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A complete or total glossectomy is a surgical procedure that involves the removal of a significant portion of the tongue, specifically more than one-half or one side of the tongue. This procedure is primarily indicated for the treatment of tongue cancer. In some cases, a tracheostomy may be performed in conjunction with the glossectomy, which involves creating an opening in the neck to facilitate breathing. The tracheostomy is typically executed through a vertical or horizontal incision made over the cricoid cartilage, allowing for access to the airway. The procedure requires careful dissection through the layers of the neck, including the removal of subcutaneous fat and separation of the strap muscles to expose the pretracheal fascia and thyroid isthmus. The thyroid isthmus is then divided to access the trachea, where an incision is made to insert a tracheostomy tube. Following the establishment of the tracheostomy, an incision is made under the mandible to gain access to the floor of the mouth, where the glossectomy is performed. The surgical team removes the affected portion of the tongue along with a margin of healthy tissue to ensure complete excision of cancerous cells. The defect created by the removal of the tongue may be closed with primary sutures, or alternatively, a skin graft or free flap graft may be utilized for reconstruction. In the case of CPT® Code 41145, the procedure is further complicated by the inclusion of a unilateral radical neck dissection, which involves the excision of lymph node groups and surrounding tissues on one side of the neck, including the removal of the sternocleidomastoid muscle, internal jugular vein, and submandibular gland, among other structures. This comprehensive approach is essential for addressing the spread of cancer and ensuring thorough treatment of the affected area.
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The complete or total glossectomy with unilateral radical neck dissection is indicated for the treatment of cancer of the tongue. This procedure is typically performed when the cancerous lesion involves a significant portion of the tongue, necessitating extensive surgical intervention to ensure complete removal of malignant tissue.
The procedure begins with the creation of a tracheostomy if necessary, which involves making a vertical or horizontal incision over the cricoid cartilage to access the airway. The surgeon carefully removes subcutaneous fat using electrocautery, followed by dissection through the platysma muscle to reach the raphe between the strap muscles. The strap muscles are then separated to expose the pretracheal fascia and thyroid isthmus, which is subsequently divided. An incision is made in the trachea to insert a tracheostomy tube, which is secured in place to facilitate breathing during the procedure. After establishing the tracheostomy, the surgeon makes an incision under the mandible to access the floor of the mouth. The mandible may be split to provide adequate access for the glossectomy. The surgical team then removes the entire tongue or a portion that involves more than half of it, ensuring that a margin of healthy tissue is included to minimize the risk of cancer recurrence. The defect created by the removal of the tongue is typically closed using primary sutures. However, if necessary, a separately reportable skin graft or free flap graft may be utilized for reconstruction. Following the glossectomy, the procedure continues with a unilateral radical neck dissection, where lymph node groups levels I-V are meticulously dissected free from surrounding tissue and excised. The surgeon removes the sternocleidomastoid muscle and the internal jugular vein on the affected side, along with the submandibular gland. Additionally, the anterior belly of the digastric muscle, as well as the sternohyoid and sternothyroid muscles, may also be excised as part of the radical neck dissection to ensure comprehensive treatment of the cancer.
Post-procedure care involves monitoring the patient for any complications related to the glossectomy and neck dissection, including potential bleeding, infection, or respiratory issues due to the tracheostomy. Patients may require pain management and supportive care as they begin the recovery process. The surgical site will need to be regularly assessed for signs of healing or infection, and drains may be placed to prevent fluid accumulation. Follow-up appointments will be necessary to evaluate the surgical outcomes and to monitor for any signs of cancer recurrence. Additionally, patients may need speech and swallowing therapy to aid in recovery and adaptation following the extensive removal of tongue tissue.
| Short Descr | TONGUE REMOVAL NECK SURGERY | Medium Descr | GLSSC COMPL/TOT W/WO TRACHS W/UNI RAD NECK DSJ | Long Descr | Glossectomy; complete or total, with or without tracheostomy, with unilateral 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 | 33 - Other OR therapeutic procedures on nose, mouth and pharynx |
| 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). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 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 | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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