How To Use CPT Code 42405

CPT 42405 describes the procedure for biopsy of the salivary gland through a skin incision. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 42405?

CPT 42405 is used to describe the biopsy of the salivary gland through a skin incision. This procedure involves the provider taking tissue samples from the salivary gland for pathological analysis. It is typically performed when there is a need to evaluate the glandular tissue for diagnostic purposes.

2. Official Description

The official description of CPT code 42405 is: ‘Biopsy of salivary gland; incisional.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. An incision is made over the salivary gland to access the glandular tissue.
3. The provider obtains multiple pieces of glandular tissue, usually around 6 to 10, for diagnostic evaluation.
4. The incision is closed using sutures.
5. The tissue samples are placed in a formalin solution and sent to a lab for pathological analysis.

4. Qualifying circumstances

CPT 42405 is performed when there is a need to obtain tissue samples from the salivary gland for diagnostic evaluation. It is typically done to assess the presence of any abnormalities or diseases affecting the glandular tissue. The procedure is performed by a qualified healthcare provider who is trained in performing salivary gland biopsies.

5. When to use CPT code 42405

CPT code 42405 should be used when a biopsy of the salivary gland is performed through a skin incision. It is important to accurately document the procedure and ensure that it meets the criteria outlined in the official description of the code.

6. Documentation requirements

To support a claim for CPT 42405, the following documentation is required:

• Patient’s diagnosis or reason for the biopsy
• Details of the procedure, including the incision made and the number of tissue samples obtained
• Date of the procedure
• Pathological analysis requested for the tissue samples
• Signature of the provider performing the biopsy

7. Billing guidelines

When billing for CPT 42405, ensure that the procedure meets the criteria outlined in the official description. It is important to accurately document the procedure and provide the necessary supporting documentation. Additionally, be aware of any specific billing guidelines or requirements set by the payer.

8. Historical information

CPT 42405 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient presents with a salivary gland mass, and the provider performs a biopsy through a skin incision to obtain tissue samples for pathological analysis.
2. A patient with recurrent salivary gland infections undergoes a biopsy of the salivary gland to investigate the underlying cause.
3. A suspicious lesion is identified in the salivary gland during imaging, prompting the provider to perform a biopsy for further evaluation.
4. A patient with symptoms of salivary gland dysfunction undergoes a biopsy to assess the glandular tissue and determine the appropriate treatment.
5. A patient with a history of salivary gland tumors undergoes regular biopsies to monitor for any recurrence or progression of the disease.