How To Use CPT Code 42500

CPT 42500 describes the primary or simple repair of an infected or damaged salivary gland. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 42500?

CPT 42500 can be used to describe the primary or simple repair of an infected or damaged salivary gland. This code is used when the provider passes a tube into the duct of the salivary gland in the mouth, leaving it in place to aid in healing. The tube is later removed after a few weeks.

2. Official Description

The official description of CPT code 42500 is: ‘Plastic repair of salivary duct, sialodochoplasty; primary or simple.’

3. Procedure

1. The provider preps and anesthetizes the patient.
2. A tube made of a material like polyethylene is passed into the duct of the salivary gland in the mouth.
3. The tube is left in place, possibly secured with sutures.
4. The tube is removed after 3 to 4 weeks as healing takes place.

4. Qualifying circumstances

CPT 42500 is performed when there is a need for primary or simple repair of an infected or damaged salivary gland. This procedure is typically done when the salivary duct is traumatized or infected.

5. When to use CPT code 42500

CPT code 42500 should be used when the provider performs primary or simple repair of an infected or damaged salivary gland. It should not be used for more complicated repairs.

6. Documentation requirements

To support a claim for CPT 42500, the provider must document the following information:

• Patient’s diagnosis and the need for primary or simple repair
• Details of the procedure, including the type of tube used and any sutures
• Date of the procedure
• Any complications or follow-up care required
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 42500, ensure that the procedure performed is a primary or simple repair of an infected or damaged salivary gland. Use the appropriate CPT code for more complicated repairs (such as 42505). It is important to follow the specific guidelines provided by the payer for accurate billing and reimbursement.

8. Historical information

CPT 42500 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes primary repair of an infected salivary gland duct.
2. A provider performs simple repair of a damaged salivary gland duct.
3. A patient with an infected salivary gland duct undergoes primary repair using a tube.
4. A provider performs simple repair of a traumatized salivary gland duct.
5. A patient undergoes primary repair of an infected salivary gland duct using a polyethylene tube.
6. A provider performs simple repair of a damaged salivary gland duct with sutures.
7. A patient with an infected salivary gland duct undergoes primary repair with a tube secured in place.
8. A provider performs simple repair of a traumatized salivary gland duct, leaving the tube in place for healing.
9. A patient undergoes primary repair of an infected salivary gland duct, with the tube removed after a few weeks.
10. A provider performs simple repair of a damaged salivary gland duct, ensuring proper healing with the tube in place.