How To Use CPT Code 42510

CPT 42510 describes a surgical procedure known as parotid duct diversion, bilateral (Wilke type procedure), with ligation of both submandibular (Wharton’s) ducts. This article will provide an overview of CPT code 42510, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 42510?

CPT 42510 is a code used to describe a surgical procedure called parotid duct diversion, bilateral (Wilke type procedure), with ligation of both submandibular (Wharton’s) ducts. This procedure is typically performed to treat sialorrhea, which is excessive drooling. It involves rerouting the parotid duct and closing off both submandibular ducts.

2. Official Description

The official description of CPT code 42510 is: ‘Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular (Wharton’s) ducts.’

3. Procedure

1. The patient is given preoperative antibiotics and dexamethasone to prevent infection and reduce inflammation.
2. The patient is placed in a supine position on the operating table.
3. 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 openings of the submandibular ducts are identified, and the surrounding mucosa is infiltrated with epinephrine to control bleeding.
7. A cuff of mucosa is incised around each opening, and the ducts are identified and dissected free from surrounding tissue.
8. The ducts are tied off with sutures to close them.
9. The opening of the parotid duct is identified and cannulated with a lacrimal probe.
10. The mucosa surrounding the opening is infiltrated with epinephrine and lidocaine to control bleeding, and the mucosa is incised.
11. The parotid duct is dissected out and relocated into the anterior tonsillar pillar using autologous vein grafts.
12. The mucosal island is secured to the anterior tonsillar pillar with sutures.
13. The procedure is repeated on the opposite side.
14. Once the procedure is complete, surgical instruments and packs are removed from the operative field.

4. Qualifying circumstances

CPT 42510 is performed on patients who experience sialorrhea, which is excessive drooling. It is typically used when other non-surgical treatments have failed to alleviate the condition. The procedure involves rerouting the parotid duct and closing off both submandibular ducts. It is important to note that this procedure is performed bilaterally, meaning it is done on both sides of the patient’s mouth.

5. When to use CPT code 42510

CPT code 42510 should be used when a patient requires a bilateral parotid duct diversion procedure with ligation of both submandibular ducts to treat sialorrhea. It is important to ensure that other non-surgical treatments have been attempted and failed before opting for this surgical intervention.

6. Documentation requirements

To support a claim for CPT code 42510, the following documentation is required:

• Patient’s medical history and diagnosis of sialorrhea
• Preoperative antibiotics and dexamethasone administration
• Details of the surgical procedure, including the steps performed
• Any complications or unexpected findings during the procedure
• Postoperative care instructions and follow-up plans
• Signature of the performing provider

7. Billing guidelines

When billing for CPT code 42510, it is important to ensure that the procedure was performed bilaterally, as indicated by the code description. Additionally, it is crucial to document the medical necessity of the procedure and provide supporting documentation. It is also important to follow any specific billing guidelines provided by the payer or insurance company.

8. Historical information

CPT code 42510 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 sialorrhea undergoes a bilateral parotid duct diversion procedure with ligation of both submandibular ducts to alleviate excessive drooling.
2. A child with cerebral palsy and sialorrhea undergoes a bilateral parotid duct diversion procedure with ligation of both submandibular ducts to manage excessive drooling.
3. An adult with Parkinson’s disease and sialorrhea undergoes a bilateral parotid duct diversion procedure with ligation of both submandibular ducts to reduce excessive drooling.
4. A patient with a history of stroke and sialorrhea undergoes a bilateral parotid duct diversion procedure with ligation of both submandibular ducts to control excessive drooling.
5. A healthcare provider performs a bilateral parotid duct diversion procedure with ligation of both submandibular ducts on a patient with sialorrhea caused by an underlying medical condition.