How To Use CPT Code 42507

CPT 42507 describes a procedure known as parotid duct diversion, specifically the bilateral Wilke type procedure. This article will provide an overview of CPT 42507, including its official description, the detailed procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 42507?

CPT 42507 is a code used to describe the bilateral Wilke type procedure, also known as parotid duct diversion. This procedure is typically performed to treat sialorrhea, which is excessive drooling. It involves rerouting the parotid ducts to alleviate the condition.

2. Official Description

The official description of CPT code 42507 is: ‘Parotid duct diversion, bilateral (Wilke type procedure).’ This procedure is performed to treat sialorrhea, which is excessive drooling.

3. Procedure

1. The patient is given preoperative antibiotics and dexamethasone to prepare for the procedure.
2. The patient is placed in a supine position on the operating table.
3. Under general anesthesia, the provider sterilizes the oral cavity and places teeth blocks to keep the mouth open.
4. A throat pack is inserted to block the throat.
5. The provider grasps the tongue with a retractor and moves it out of the field of dissection.
6. The opening of a parotid duct is identified and cannulated with a lacrimal probe.
7. The mucosa surrounding the opening is infiltrated with epinephrine and lidocaine to control bleeding.
8. Once vasoconstriction is evident, the provider incises the mucosa.
9. The parotid duct is dissected out and relocated via a submucosal tunnel into the anterior tonsillar pillar using autologous vein grafts.
10. The procedure is repeated on the opposite side.
11. After completion, all instruments and packs are removed from the surgical field.

4. Qualifying circumstances

CPT 42507 is performed to treat sialorrhea, which is excessive drooling. It is typically indicated for patients with conditions such as mental retardation, cerebral palsy, Parkinson’s disease, or those who have had a stroke. The procedure involves rerouting the parotid ducts to alleviate the excessive drooling.

5. When to use CPT code 42507

CPT code 42507 should be used when performing the bilateral Wilke type procedure for parotid duct diversion to treat sialorrhea. It is important to ensure that the procedure is medically necessary and appropriate for the patient’s condition.

6. Documentation requirements

To support a claim for CPT 42507, the following documentation is required:

• Medical necessity for the procedure to treat sialorrhea
• Details of the procedure performed, including the bilateral Wilke type procedure
• Date of the procedure
• Preoperative antibiotics and dexamethasone administration
• Specific steps taken during the procedure, such as sterilization, teeth blocks, throat pack insertion, tongue retraction, cannulation, mucosa infiltration, incision, dissection, relocation, and removal of instruments and packs
• Any complications or additional procedures performed
• Signature of the provider who performed the procedure

7. Billing guidelines

When billing for CPT 42507, it is important to ensure that the procedure performed is the bilateral Wilke type procedure for parotid duct diversion. Modifier 50 should not be added as this is already a bilateral procedure. If only one submandibular gland was excised or ligated, modifier 22 may be added. Prior approval should be obtained from the payer to determine coverage for the procedure.

8. Historical information

CPT 42507 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 with cerebral palsy undergoing the bilateral Wilke type procedure for parotid duct diversion to treat sialorrhea.
2. An adult with Parkinson’s disease receiving the bilateral Wilke type procedure for parotid duct diversion to alleviate excessive drooling.
3. A child with mental retardation undergoing the bilateral Wilke type procedure for parotid duct diversion to manage sialorrhea.
4. A stroke survivor receiving the bilateral Wilke type procedure for parotid duct diversion to address excessive drooling.
5. A patient with a history of excessive drooling due to an unknown cause undergoing the bilateral Wilke type procedure for parotid duct diversion.
6. A bilateral Wilke type procedure for parotid duct diversion performed on a patient with sialorrhea caused by cerebral palsy.
7. A patient with Parkinson’s disease undergoing the bilateral Wilke type procedure for parotid duct diversion to alleviate excessive drooling.
8. A child with mental retardation receiving the bilateral Wilke type procedure for parotid duct diversion to manage sialorrhea.
9. A stroke survivor undergoing the bilateral Wilke type procedure for parotid duct diversion to address excessive drooling.
10. A patient with a history of excessive drooling due to an unknown cause receiving the bilateral Wilke type procedure for parotid duct diversion.