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The procedure described by CPT® Code 42892 involves the surgical resection of the lateral wall of the pharynx or the pyriform sinus, followed by direct closure of the surgical site through the advancement of the lateral and posterior pharyngeal walls. The pyriform sinus, also known as the pyriform fossa, is a funnel-shaped recess located in the anterolateral wall of the nasopharynx, adjacent to the vestibule of the larynx. This surgical intervention is primarily indicated for the treatment of malignant tumors affecting the pharynx or pyriform sinus, although it may also be utilized for the excision of benign lesions or strictures that may obstruct normal function. The procedure begins with a horizontal incision made in the neck, specifically over the thyrohyoid membrane, allowing access to the underlying structures. The suprahyoid muscles are carefully separated from the hyoid bone laterally to facilitate exposure of the pharynx. By retracting the larynx inferiorly and the tongue superiorly, the surgeon gains access to the valleculae and the lateral pharynx, where the lesion or defect is identified. The excision of the lesion is performed with a margin of healthy tissue to ensure complete removal. Following the resection, the defect is closed by mobilizing the lateral and posterior pharyngeal walls, which are then approximated and sutured together to restore the integrity of the pharyngeal structure.
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The procedure described by CPT® Code 42892 is indicated for the following conditions:
The surgical procedure begins with the creation of a horizontal incision in the neck, specifically positioned over the thyrohyoid membrane. This incision allows the surgeon to access the deeper structures of the neck. Following the incision, the suprahyoid muscles are carefully separated from the hyoid bone laterally, which facilitates better exposure of the pharynx. Once the muscles are retracted, the surgeon enters the valleculae, a space located at the base of the tongue, and further exposes the pharynx by retracting the larynx inferiorly and the tongue superiorly. This maneuver provides a clear view of the lateral pharynx and/or pyriform sinus, where the lesion or defect is identified. The next step involves the excision of the lesion along with a margin of healthy tissue to ensure complete removal of any potentially malignant cells. After the lesion is excised, the focus shifts to closing the defect. In CPT® Code 42892, the closure is achieved by advancing the lateral and posterior pharyngeal walls. The surgeon mobilizes these walls and approximates the edges of the incision, securing them with sutures to restore the anatomical integrity of the pharynx.
Post-procedure care following the resection of the lateral pharyngeal wall or pyriform sinus typically involves monitoring for any complications such as bleeding or infection. Patients may require pain management and should be advised on dietary modifications to facilitate healing. Follow-up appointments are essential to assess the surgical site and ensure proper recovery. Additionally, any necessary imaging or further evaluations may be scheduled to monitor for recurrence of lesions or other complications related to the initial condition that warranted the surgery.
| Short Descr | REVISION OF PHARYNGEAL WALLS | Medium Descr | RESCJ LAT PHRNGL WALL/PYRIFORM SINUS DIR CLSR | Long Descr | Resection of lateral pharyngeal wall or pyriform sinus, direct closure by advancement of lateral and posterior pharyngeal walls | 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) | 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 |
| 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). | 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.) | 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) | 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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