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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 disorders, such as cerebral palsy or traumatic brain injuries, which can disrupt the normal regulation of saliva production. The procedure involves the diversion of the parotid ducts, which are responsible for draining saliva from the parotid glands, one of the three major pairs of 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 tissues, preserving a cuff of mucosa, and are then repositioned to the tonsillar fossae, where they are secured with sutures. In conjunction with this diversion, the procedure also entails the ligation and division of both submandibular ducts, known as Wharton's ducts, which further aids in reducing saliva flow. This comprehensive approach is designed to alleviate the symptoms of sialorrhea by effectively managing the pathways through which saliva is secreted into the oral cavity.
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The bilateral parotid duct diversion procedure (CPT® Code 42510) is indicated for patients experiencing excessive salivation, or sialorrhea, which can lead to uncontrolled drooling. This condition is often a result of various neurological deficits, including:
The bilateral parotid duct diversion procedure involves several critical steps to ensure effective treatment of sialorrhea. The procedure is performed under general anesthesia, and the following steps are executed:
After the bilateral parotid duct diversion procedure, patients are typically monitored for any immediate complications. Post-operative care may include managing pain and monitoring for signs of infection at the incision sites. Patients may also be advised on dietary modifications to accommodate the changes in saliva production. Recovery time can vary, but patients are generally expected to follow up with their healthcare provider to assess healing and the effectiveness of the procedure in reducing sialorrhea. Additional considerations may include speech therapy or other supportive measures to assist with any ongoing challenges related to saliva control.
| Short Descr | PAROTID DUCT DIVERSION | Medium Descr | PAROTID DUCT DVRJ BILATERAL WITH LIG BOTH DUCTS | Long Descr | Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular (Wharton's) ducts | 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) | 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 | 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) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 33 - Other OR therapeutic procedures on nose, mouth and pharynx |
| 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). | LT | Left side (used to identify procedures performed on the left side of the body) |
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| Pre-1990 | Added | Code added. |
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