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Pharyngostomy is a surgical procedure that involves creating an opening in the pharynx, specifically for the purpose of external feeding or drainage. This procedure is typically indicated in cases where there has been significant injury or surgical intervention at a more proximal location in the pharynx, which may impede normal swallowing and require alternative methods for nutrition and secretion management. In instances of extensive injury or surgical removal of the pharynx without subsequent reconstruction, a pharyngostomy allows for the effective drainage of saliva and mucus, thereby preventing aspiration and other complications. The procedure involves making an incision in the lateral aspect of the neck, through which the proximal segment of the pharynx is brought out, everted, and sutured to the skin. This creates a stoma, or opening, through which a feeding tube or drainage device can be inserted, facilitating either nutritional support or the management of secretions. The careful execution of this procedure is crucial for patient recovery and quality of life, particularly in those unable to ingest food orally due to their medical condition.
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Pharyngostomy is indicated in specific clinical scenarios where normal swallowing is compromised or where there is a need for external management of secretions. The following conditions may warrant the performance of a pharyngostomy:
The procedure for pharyngostomy involves several critical steps to ensure proper placement and function of the stoma. The following outlines the procedural steps:
Post-procedure care for patients who have undergone a pharyngostomy is crucial for recovery and includes monitoring the stoma site for signs of infection, ensuring the tube remains patent, and managing any drainage or feeding protocols as indicated. Patients may require education on stoma care and the use of feeding devices. Regular follow-up appointments are essential to assess healing and to make any necessary adjustments to the feeding or drainage regimen. Additionally, healthcare providers should be vigilant for any complications that may arise, such as tube dislodgment or blockage, and address these promptly to ensure optimal patient outcomes.
| Short Descr | SURGICAL OPENING OF THROAT | Medium Descr | PHARYNGOSTOMY FSTLJ PHARYNX XTRNL FEEDING | Long Descr | Pharyngostomy (fistulization of pharynx, external for feeding) | 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) | 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 | 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). | 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. | 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.) | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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