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Official Description

Dilation and catheterization of salivary duct, with or without injection

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 42660 involves the dilation and catheterization of a salivary duct, which is performed to address a narrowing of the duct, known as stenosis or stricture. This condition can impede the normal flow of saliva, leading to discomfort and potential complications. The procedure may be conducted with or without the injection of contrast material, which aids in visualizing the duct during the process. Initially, local anesthetic is administered to the mucosa surrounding the salivary duct to minimize discomfort during the procedure. The technique involves the use of a guidewire that is inserted into the duct's opening, or papilla, and advanced to the area of narrowing. A balloon catheter is then introduced over the guidewire and positioned at the stenotic site. The balloon is inflated and deflated multiple times to achieve the desired dilation of the duct. Following the dilation, contrast material may be injected to confirm the success of the procedure, and radiographs can be obtained to visualize the duct's patency. This comprehensive approach ensures that the salivary duct is adequately treated, restoring normal function and alleviating symptoms associated with the stenosis.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The dilation and catheterization of the salivary duct, as described by CPT® Code 42660, is indicated for the treatment of conditions that involve narrowing of the salivary duct. These conditions may include:

  • Salivary Duct Stenosis - A condition characterized by the narrowing of the salivary duct, which can lead to obstruction and impaired saliva flow.
  • Salivary Duct Stricture - A similar condition where the duct is constricted, causing difficulties in salivary drainage and potential complications such as infection or swelling.

2. Procedure

The procedure for dilation and catheterization of the salivary duct involves several key steps, which are detailed as follows:

  • Step 1: Anesthesia Administration - The procedure begins with the administration of a local anesthetic to the mucosa surrounding the salivary duct. This step is crucial for minimizing discomfort during the subsequent stages of the procedure.
  • Step 2: Guidewire Insertion - A guidewire is carefully inserted into the duct papilla, which is the opening of the salivary duct. The guidewire is advanced through the duct until it reaches the area of stenosis, allowing for precise navigation within the ductal system.
  • Step 3: Balloon Catheter Placement - Once the guidewire is in place, a balloon catheter is passed over the guidewire and maneuvered to the stenotic region. This step is critical for preparing the duct for dilation.
  • Step 4: Dilation of the Stenotic Region - The guidewire is then removed, and the balloon catheter is inflated at the site of the stenosis. The balloon is inflated and deflated several times to gradually dilate the narrowed area, ensuring that the duct achieves the desired diameter.
  • Step 5: Contrast Injection and Imaging - Following the dilation, contrast material may be injected into the duct to assess the success of the procedure. Radiographs are obtained to visualize the duct and confirm that the dilation has effectively restored patency.

3. Post-Procedure

After the completion of the dilation and catheterization procedure, patients may be monitored for any immediate complications or adverse reactions to the anesthesia or contrast material. It is important to assess the patient's recovery and ensure that they are stable before discharge. Patients may be advised on post-procedure care, which could include recommendations for hydration and monitoring for any signs of infection or complications. Follow-up appointments may be scheduled to evaluate the long-term success of the procedure and to address any ongoing symptoms related to salivary duct function.

Short Descr DILATION OF SALIVARY DUCT
Medium Descr DILAT&CATHJ SALIVARY DUCT W/WO INJECTION
Long Descr Dilation and catheterization of salivary duct, with or without injection
Status Code Active Code
Global Days 000 - Endoscopic or Minor Procedure
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) 0 - Payment restriction for assistants at surgery applies 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 Procedure or Service, Multiple Reduction Applies
ASC Payment Indicator Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P6C - Minor procedures - other (Medicare fee schedule)
MUE 2
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).
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.
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).
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.
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).
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)
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
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