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A bilateral parotid duct diversion, commonly known as a Wilke procedure, is a surgical intervention aimed at addressing excessive salivation, medically referred to as sialorrhea. This condition often leads to uncontrolled drooling, which can significantly impact a patient's quality of life. Sialorrhea is frequently associated with neurological deficits, such as those seen in individuals with cerebral palsy or following a head injury. The procedure involves the manipulation of the parotid ducts, which are responsible for transporting saliva from the parotid glands, one of the three major paired salivary glands in the human body, alongside the submandibular and sublingual glands. During the Wilke procedure, the parotid ducts are meticulously dissected from the surrounding tissue while preserving a cuff of mucosa. This careful dissection is crucial for the subsequent steps, where each duct is transposed to the tonsillar fossae and secured in place with sutures. This diversion effectively reduces the flow of saliva into the oral cavity, thereby alleviating the symptoms of sialorrhea and improving the patient's overall comfort and social interactions.
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The bilateral parotid duct diversion procedure is indicated for patients experiencing excessive salivation, known as sialorrhea, which can lead to uncontrolled drooling. This condition is often a result of neurological deficits, including but not limited to:
The bilateral parotid duct diversion procedure involves several critical steps to ensure successful outcomes. Each step is performed with precision to minimize complications and achieve the desired therapeutic effect.
Post-procedure care is essential for optimal recovery and includes monitoring for any complications that may arise. Patients may experience some discomfort or swelling in the surgical area, which can be managed with appropriate pain relief measures. It is important for healthcare providers to provide instructions on wound care and signs of infection to watch for during the recovery period. Follow-up appointments will be necessary to assess the success of the procedure and to ensure that the patient is adapting well to the changes in saliva management.
| Short Descr | PAROTID DUCT DIVERSION | Medium Descr | PAROTID DUCT DIVERSION BILATERAL WILKE PX | Long Descr | Parotid duct diversion, bilateral (Wilke type procedure); | 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) | 2 - 150% payment adjustment 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) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - 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). | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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