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The procedure described by CPT® Code 42665 involves the ligation of a salivary duct within the oral cavity. This surgical intervention is primarily indicated for the management of excessive salivation, clinically known as sialorrhea, which can lead to uncontrolled drooling. Sialorrhea is often associated with neurological conditions, such as cerebral palsy or traumatic brain injuries, which can disrupt the normal regulation of saliva production. The salivary glands responsible for saliva secretion include the parotid, submandibular, and sublingual glands. The parotid glands, which are the largest, have ducts known as Stensen's ducts that open into the buccal cavity near the upper second molar. The submandibular glands, also referred to as submaxillary glands, have ducts called Wharton's ducts that open on the floor of the mouth adjacent to the frenulum of the tongue. The sublingual glands possess multiple ducts that also drain into the floor of the mouth, with some potentially merging with Wharton's duct. During the ligation procedure, the duct is identified, cannulated for a short distance, and an incision is made to expose the duct. The duct is then ligated in two locations to reduce saliva flow, and the incision may be sutured closed or allowed to heal naturally. This procedure aims to alleviate the symptoms of sialorrhea and improve the quality of life for affected individuals.
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The ligation of the salivary duct is performed for specific indications related to excessive salivation, known as sialorrhea. The following conditions may warrant this procedure:
The ligation of the salivary duct involves several key procedural steps that are critical for successful execution:
After the ligation of the salivary duct, patients may require specific post-procedure care to ensure proper healing and recovery. It is important to monitor the surgical site for any signs of infection or complications. Patients may be advised on oral hygiene practices to maintain cleanliness in the area of the incision. Additionally, follow-up appointments may be scheduled to assess the effectiveness of the procedure in reducing sialorrhea and to address any concerns that may arise during the recovery period.
| Short Descr | LIGATION OF SALIVARY DUCT | Medium Descr | LIGATION SALIVARY DUCT INTRAORAL | Long Descr | Ligation salivary duct, intraoral | 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) | 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 | 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 | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| Pre-1990 | Added | Code added. |
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