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The procedure described by CPT® Code 42426 involves the excision of a tumor from the parotid gland, which is the largest of the three major paired salivary glands located beneath and in front of the ear. This surgical intervention is comprehensive, as it includes a total removal of the parotid gland along with a unilateral radical neck dissection. The approach begins with an incision made just anterior to the auricle of the ear, which is then extended around the ear lobe and along the mandible. This incision allows for the elevation of a skin flap, providing access to the parotid gland. During the procedure, careful dissection is performed to separate the inferior aspect of the parotid gland from the sternocleidomastoid muscle, continuing until the digastric muscle is reached. The surgical team meticulously dissects the tissue located anterior to the tip and superior to the tragus to expose the trunk of the facial nerve. To ensure the preservation of nerve function, a nerve stimulator is utilized to identify the branches of the facial nerve. In cases where the tumor has invaded the facial nerve, an en bloc removal of both the parotid gland and the tumor is conducted, which may necessitate sacrificing the facial nerve. Hemostasis is achieved using electrocautery, and a drain is placed through a separate incision behind the ear to manage any postoperative fluid accumulation. Following the parotid gland excision, a radical neck dissection is performed, which involves the meticulous removal of lymph node groups from levels I to V, along with surrounding tissues. This extensive dissection may also include the removal of the sternocleidomastoid muscle, internal jugular vein, submandibular gland on the affected side, and potentially the anterior belly of the digastric muscle, as well as the sternohyoid and sternothyroid muscles. The surgical wounds are then repaired, and suction drains are placed as necessary to facilitate recovery.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 42426 is indicated for the excision of tumors located in the parotid gland. This may include various types of neoplasms that have been diagnosed through imaging or biopsy. The presence of a tumor that has invaded surrounding structures, particularly the facial nerve, necessitates this extensive surgical intervention. Additionally, the procedure may be indicated in cases where there is a need for radical neck dissection due to the involvement of lymph nodes in the neck region, which may be associated with malignancies originating from the parotid gland.
The procedure begins with the creation of an incision just anterior to the auricle of the ear, which is then extended around the ear lobe and along the mandible. This incision allows for the elevation of a skin flap, exposing the parotid gland. The surgeon carefully dissects the inferior aspect of the parotid gland from the sternocleidomastoid muscle, continuing the dissection until reaching the digastric muscle. This meticulous dissection is crucial for accessing the facial nerve, which is located anterior to the tip and superior to the tragus. A nerve stimulator is employed to identify the branches of the facial nerve, ensuring that they are preserved whenever possible. Once the parotid gland is adequately exposed, it is divided and retracted to allow for a clear view of the nerve branches. In cases where the tumor has invaded the facial nerve, an en bloc removal of the entire parotid gland along with the tumor is performed, which may involve sacrificing the facial nerve to ensure complete tumor removal. To control any bleeding during the procedure, electrocautery is utilized. After the parotid gland excision, a drain is placed through a separate incision located behind the ear to manage postoperative fluid accumulation. Following the parotid gland excision, a radical neck dissection is performed. This involves the careful dissection and excision of lymph node groups from levels I to V, which are freed from surrounding tissue. The procedure may also necessitate the removal of the sternocleidomastoid muscle and the internal jugular vein, as well as the submandibular gland on the affected side. Additionally, the anterior belly of the digastric muscle, along with the sternohyoid and sternothyroid muscles, may also be excised if deemed necessary. Finally, the surgical wounds are repaired, and suction drains are placed as needed to facilitate recovery.
Post-procedure care following the excision of the parotid tumor and radical neck dissection involves monitoring for complications such as bleeding, infection, and nerve damage. Patients may require pain management and should be observed for any signs of facial nerve dysfunction due to the nature of the surgery. The drain placed behind the ear will typically be monitored and may be removed once the output decreases to an acceptable level. Patients are advised on wound care and signs of infection to watch for during their recovery. Follow-up appointments are essential to assess healing and to monitor for any recurrence of the tumor or complications related to the surgery.
| Short Descr | EXCISE PAROTID GLAND/LESION | Medium Descr | EXC PRTD TUM/PRTD GLND TOT W/UNI RAD NCK DSJ | Long Descr | Excision of parotid tumor or parotid gland; total, 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) | 1 - 150% payment adjustment for bilateral procedures applies. | 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. | 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 | 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) | RT | Right side (used to identify procedures performed on the right side of the body) |
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