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A glossectomy is a surgical procedure that involves the removal of part or all of the tongue. In the context of CPT® Code 41155, this procedure is performed as a composite operation that includes not only the glossectomy but also the resection of the floor of the mouth, a mandibular resection, and a radical neck dissection, commonly referred to as a Commando procedure. This complex surgical intervention is primarily indicated for the treatment of cancers affecting the tongue and oropharynx, particularly when there is involvement of the mandible. The procedure begins with the resection of the mandible, which is accessed through a visor flap technique. This technique entails making an incision along the lower gingival buccal sulcus, allowing for the elevation of the skin over the chin and lower lip to access the mandible. Following the mandible's resection, the mucosa of the floor of the mouth is incised to remove diseased tissue along with a margin of healthy tissue, which typically includes the soft tissue beneath the sublingual glands and may involve transection of the Wharton duct. The procedure also necessitates the removal of the affected portion of the tongue, again with a margin of healthy tissue. The resulting defects from this extensive resection are often repaired through additional reconstructive surgeries, which may involve skin grafts, free flap grafts, or mandibular reconstruction. It is important to note that CPT® Code 41155 is specifically utilized when the composite procedure is performed in conjunction with a radical neck dissection, which entails the excision of lymph node groups levels I-V, along with the removal of surrounding tissues, including the sternocleidomastoid muscle, internal jugular vein, and submandibular gland on the affected side, as well as potentially the anterior belly of the digastric muscle and the sternohyoid and sternothyroid muscles.
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The glossectomy procedure described by CPT® Code 41155 is indicated for the treatment of specific conditions, particularly:
The procedure involves several critical steps, each essential for the successful execution of the composite surgical intervention:
After the completion of the glossectomy and associated procedures, post-operative care is critical for patient recovery. Patients may require monitoring for complications such as bleeding, infection, or issues related to the surgical site. Pain management will be an essential component of post-operative care, and patients may need assistance with nutrition and speech therapy as they recover from the extensive tissue removal. The defects created by the surgery are typically addressed through separate reconstructive surgeries, which may involve skin grafts or free flap grafts to restore function and appearance. Follow-up appointments will be necessary to assess healing and to monitor for any signs of cancer recurrence.
| Short Descr | TONGUE JAW & NECK SURGERY | Medium Descr | GLSSC COMPOSIT RESCJ FLR MNDBLR RESCJ & RAD NECK | Long Descr | Glossectomy; composite procedure with resection floor of mouth, mandibular resection, and radical neck dissection (Commando type) | 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. | 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.) | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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). | 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 | 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) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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