CPT® Code 78232

Official Description

Salivary gland function study

Common Language Description

A salivary gland function study, as described by CPT® Code 78232, is a diagnostic procedure that evaluates the performance of the salivary glands, which include the parotid, submandibular, and sublingual glands. These exocrine glands are essential components of the oral cavity, responsible for the secretion of saliva, a fluid that plays a crucial role in the digestion of food and maintaining oral hygiene. The parotid glands are situated anterior and inferior to the ears, releasing saliva into the mouth through the Stensen ducts. The submandibular glands are located on the floor of the mouth, with saliva being secreted via the Warthin ducts. Similarly, the sublingual glands, also found on the floor of the mouth and lateral to the tongue, secrete saliva through both the Warthin and sublingual ducts. The function study of these glands is particularly valuable in diagnosing conditions such as Sjogren's syndrome, which is characterized by dry mouth (xerostomia), and can also identify duct obstructions caused by stones, inflammation, or tumors. The procedure involves the establishment of an intravenous line through which a radiolabeled isotope tracer is injected into the patient's circulatory system. Following a designated waiting period, the patient is positioned on an imaging table, and a gamma camera is placed over the anterior head and neck area. Scanning occurs at specific intervals to capture the radioactive energy emitted from the salivary glands, which is then converted into images for analysis. To further stimulate saliva production, the patient is administered lemon juice orally, prompting the glands to secrete saliva into the mouth, after which a second set of images is obtained. The physician interprets the results of the salivary gland function study and compiles a comprehensive written report detailing the findings.

1. Indications

The salivary gland function study is indicated for the evaluation of various conditions affecting the salivary glands. The following are specific indications for performing this procedure:

Sjogren's syndrome - A chronic autoimmune disorder characterized by dry mouth and dry eyes due to the destruction of salivary and lacrimal glands.
Xerostomia (dry mouth) - A condition where there is a reduced or absent saliva flow, which can lead to difficulties in swallowing, speaking, and increased risk of dental caries.
Duct obstruction - This may occur due to the presence of stones, inflammation, or tumors that block the salivary ducts, impeding saliva flow.

2. Procedure

The salivary gland function study involves several key procedural steps that are crucial for obtaining accurate diagnostic results. The following outlines the detailed steps of the procedure:

Step 1: Establishing intravenous access - An intravenous line is established to facilitate the injection of a radiolabeled isotope tracer into the patient's circulatory system. This step is essential for the subsequent imaging process.
Step 2: Injection of the radiolabeled tracer - The radiolabeled isotope tracer is injected through the intravenous line. This tracer is critical as it allows for the visualization of salivary gland function during the imaging process.
Step 3: Patient positioning and initial scanning - After a prescribed waiting period to allow the tracer to circulate, the patient is positioned on the imaging table. A gamma camera is then placed over the anterior head and neck area to begin the scanning process.
Step 4: Image acquisition - Scanning is performed at specific intervals to capture the radioactive energy emitted from the salivary glands. This energy is converted into images that reflect the functional status of the glands.
Step 5: Saliva stimulation - To enhance saliva production for further evaluation, the patient is given lemon juice orally. This stimulation prompts the salivary glands to secrete saliva into the mouth.
Step 6: Second image acquisition - Following the administration of lemon juice, a second set of images is obtained to assess the glands' response to stimulation and to evaluate the flow of saliva.

3. Post-Procedure

After the completion of the salivary gland function study, the physician interprets the images obtained during the procedure. A comprehensive written report is generated, detailing the findings and any abnormalities observed in the salivary gland function. Patients may be monitored for any immediate reactions to the tracer, although serious side effects are rare. It is important for patients to follow any specific post-procedure instructions provided by the healthcare team, which may include hydration recommendations or follow-up appointments to discuss the results.

Short Descr	SALIVARY GLAND FUNCTION STD
Medium Descr	SALIVARY GLAND FUNCTION STUDY
Long Descr	Salivary gland function study
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51)	0 - No 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, Not Discounted when Multiple
ASC Payment Indicator	Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight.
Type of Service (TOS)	4 - Diagnostic Radiology
Berenson-Eggers TOS (BETOS)	I1E - Standard imaging - nuclear medicine
MUE	1
CCS Clinical Classification	209 - Radioisotope scan and function studies

26	Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
GC	This service has been performed in part by a resident under the direction of a teaching physician
MG	The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional
X5	Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician