How To Use CPT Code 42600

CPT 42600 describes the closure of a salivary fistula, which is an abnormal passage between a salivary duct and the cutaneous surface of the oral cavity. 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 42600?

CPT 42600 is used to describe the closure of a salivary fistula, which is an abnormal passage between a salivary duct and the cutaneous surface of the oral cavity. This procedure involves the removal and repair of the abnormal tube-like passage through a process called anastomosis, where the passage is reconnected.

2. Official Description

The official description of CPT code 42600 is the closure of a salivary fistula, which is an abnormal passage between a salivary duct and the cutaneous surface of the oral cavity. This procedure involves the removal and repair of the abnormal tube-like passage through anastomosis.

3. Procedure

1. The physician assesses the salivary fistula and determines the need for closure.
2. The abnormal tube-like passage between the salivary duct and the cutaneous surface of the oral cavity is removed.
3. The physician performs an anastomosis, reconnecting the passage to restore normal salivary flow.
4. The closure of the salivary fistula is completed, ensuring proper healing and prevention of further complications.

4. Qualifying circumstances

CPT 42600 is performed when a patient has a salivary fistula, which is an abnormal passage between a salivary duct and the cutaneous surface of the oral cavity. This condition may occur due to injury or infection. The physician must determine the need for closure based on the patient’s specific circumstances and the severity of the fistula.

5. When to use CPT code 42600

CPT code 42600 should be used when a physician performs the closure of a salivary fistula. This code is appropriate when the abnormal passage between the salivary duct and the cutaneous surface of the oral cavity is removed and repaired through anastomosis. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 42600, the physician must document the following information:

• Patient’s diagnosis of a salivary fistula
• Details of the closure procedure, including the removal of the abnormal passage and the anastomosis performed
• Date of the procedure
• Any complications or follow-up care required
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 42600, ensure that the closure of a salivary fistula has been performed through anastomosis by a qualified physician. Follow the appropriate coding guidelines and ensure accurate documentation to support the claim. It is important to review any specific billing requirements from the payer to ensure proper reimbursement.

8. Historical information

CPT 42600 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 fistula resulting from a previous injury. The physician performs the closure of the fistula through anastomosis, ensuring proper healing and restoration of normal salivary flow.
2. After an infection, a patient develops a salivary fistula. The physician removes the abnormal passage and reconnects the salivary duct through anastomosis, successfully closing the fistula and preventing further complications.
3. A patient undergoes surgery that inadvertently leads to the formation of a salivary fistula. The physician performs the closure procedure, removing the abnormal passage and restoring normal salivary function through anastomosis.
4. Following a traumatic injury, a patient develops a salivary fistula. The physician performs the closure procedure, removing the abnormal passage and reconnecting the salivary duct to ensure proper healing and prevent further complications.
5. A patient presents with a chronic salivary fistula that has not resolved with conservative management. The physician performs the closure procedure through anastomosis, successfully closing the fistula and restoring normal salivary flow.