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The procedure described by CPT® Code 42894 involves the surgical resection of the lateral wall of the pharynx or the pyriform sinus, which 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 operation 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. Once the valleculae are accessed, the larynx is retracted inferiorly while the tongue is elevated superiorly, providing a clear view of the lateral pharynx and/or pyriform sinus. The surgeon identifies the lesion or defect, which is then excised along with a margin of healthy tissue to ensure complete removal of any malignant cells. Unlike the procedure described in CPT® Code 42892, where the defect is closed by advancing the lateral and posterior pharyngeal walls, CPT® Code 42894 requires the use of a myocutaneous flap for closure. Commonly utilized flaps for this purpose include the latissimus dorsi and pectoralis major flaps. The procedure involves careful planning and measurement of the defect size, marking the skin over the flap site, and identifying the vessels that supply the flap. The flap is then developed by incising the skin and muscle, rotated into the neck with the skin side facing inward, and sutured to the pharyngeal wall to effectively close the defect. Finally, the overlying subcutaneous tissue and skin are closed over the flap, completing the surgical reconstruction.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 42894 is indicated for the following conditions:
The surgical procedure begins with a horizontal incision made in the neck over the thyrohyoid membrane. This incision allows the surgeon to gain access to the underlying anatomical structures. Following the incision, the suprahyoid muscles are carefully separated from the hyoid bone laterally, which is essential for exposing the pharynx adequately. Once the muscles are retracted, the valleculae are entered, and the pharynx is further exposed by retracting the larynx inferiorly and elevating 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 surgeon then excises the lesion or defect along with a margin of healthy tissue to ensure complete removal of any potentially malignant cells. In contrast to the procedure described in CPT® Code 42892, where the defect is closed by advancing the lateral and posterior pharyngeal walls, CPT® Code 42894 necessitates the use of a myocutaneous flap for closure. Commonly used flaps include the latissimus dorsi and pectoralis major. If a pectoralis major flap is selected, the size of the defect is measured, and the skin over the planned flap site is marked accordingly. The surgeon identifies the vessels supplying the flap, which is crucial for ensuring adequate blood supply postoperatively. The skin and muscle are then incised, and the flap is developed carefully. Once the flap is prepared, it is rotated into the neck with the skin side facing inward and sutured to the pharyngeal wall to effectively close the defect. Finally, the overlying subcutaneous tissue and skin are closed over the flap, completing the reconstruction of the pharyngeal wall.
Post-procedure care following the resection of the pharyngeal wall with closure using a myocutaneous flap involves monitoring the surgical site for any signs of complications, such as infection or flap failure. Patients may require pain management and should be advised on dietary modifications to accommodate any temporary swallowing difficulties. Follow-up appointments are essential to assess the healing process and ensure that the flap is integrating properly with the surrounding tissues. Additionally, speech therapy may be recommended to assist with any changes in swallowing or speech function resulting from the surgery. Overall, the recovery process will vary depending on the individual patient's health status and the extent of the surgical procedure performed.
| Short Descr | REVISION OF PHARYNGEAL WALLS | Medium Descr | RESCJ PHRNGL WALL CLSR W/FLP OR FLP W/MVASC ANAS | Long Descr | Resection of pharyngeal wall requiring closure with myocutaneous or fasciocutaneous flap or free muscle, skin, or fascial flap with microvascular anastomosis | 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 | Inpatient Procedures, not paid under OPPS | 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 |
| 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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. | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | 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) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2014-01-01 | Changed | Code description changed. |
| 2013-01-01 | Changed | Per AMA corrections document, revised misspelled word "anastomosis". |
| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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