How To Use CPT Code 42890

CPT 42890 describes the procedure for limited pharyngectomy, which involves the removal of part of the pharyngeal wall, including the thyroid ala, hyoid bone, and wall of the piriform fossa. This article will provide an overview of CPT code 42890, 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 42890?

CPT 42890 is used to describe the limited pharyngectomy procedure, which involves the removal of a portion of the pharyngeal wall, including the thyroid ala, hyoid bone, and wall of the piriform fossa. This code is used when the provider performs the procedure to address a specific pharyngeal lesion or condition. It is important to note that CPT 42890 should not be used for resection of the lateral pharyngeal wall or pyriform sinus with direct closure or when closure requires myocutaneous or fasciocutaneous flap or free muscle, skin, or fascial flap with microvascular anastomosis.

2. Official Description

The official description of CPT code 42890 is: ‘Limited pharyngectomy; partial pharyngectomy, with removal of pharyngeal wall, thyroid ala, hyoid bone, and wall of piriform fossa.’

3. Procedure

1. The provider begins by making an incision on the patient’s neck and deepening it to access the hyoid and sternomastoid muscles.
2. Next, the provider dissects the layer of cervical fibrous tissue free from the hyoid bone.
3. A portion of the hyoid bone is then further divided to gain access to the pharyngeal structure.
4. The provider removes a portion of the pharynx, which may include the removal of part of the thyroid ala, hyoid bone, and wall of the piriform fossa.
5. After removing the pharyngeal lesion, the surgical wound is thoroughly flushed and closed with interrupted sutures once hemostasis is achieved.

4. Qualifying circumstances

CPT 42890 is performed when there is a need to remove a specific pharyngeal lesion or address a condition that requires the removal of part of the pharyngeal wall, including the thyroid ala, hyoid bone, and wall of the piriform fossa. It is important to note that this code should not be used for other types of pharyngeal resections that require different closure techniques.

5. When to use CPT code 42890

CPT code 42890 should be used when the provider performs a limited pharyngectomy procedure, removing part of the pharyngeal wall, thyroid ala, hyoid bone, and wall of the piriform fossa. It is important to ensure that the procedure performed aligns with the specific requirements outlined in the code description.

6. Documentation requirements

To support a claim for CPT code 42890, the provider must document the following information:

• Patient’s diagnosis necessitating the limited pharyngectomy
• Details of the procedure performed, including the specific structures removed
• Date of the procedure
• Any additional procedures or techniques used during the surgery
• Any complications or unexpected findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 42890, ensure that the procedure performed aligns with the specific requirements outlined in the code description. It is important to note that CPT code 42890 should not be reported with other codes for different types of pharyngeal resections or closures. Additional tips for accurate billing may include considering the location of the testing and the need for hemostasis control.

8. Historical information

CPT code 42890 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 provider performs a limited pharyngectomy to remove a pharyngeal lesion involving the thyroid ala, hyoid bone, and wall of the piriform fossa.
2. During a surgical procedure, a provider removes part of the pharyngeal wall, including the thyroid ala, hyoid bone, and wall of the piriform fossa, to address a specific condition.
3. A patient undergoes a limited pharyngectomy to remove a pharyngeal lesion that involves the removal of the thyroid ala, hyoid bone, and wall of the piriform fossa.
4. As part of a treatment plan, a provider performs a limited pharyngectomy to remove a portion of the pharyngeal wall, including the thyroid ala, hyoid bone, and wall of the piriform fossa.
5. A limited pharyngectomy is performed to address a specific pharyngeal lesion, involving the removal of the thyroid ala, hyoid bone, and wall of the piriform fossa.
6. During a surgical procedure, a provider removes part of the pharyngeal wall, including the thyroid ala, hyoid bone, and wall of the piriform fossa, to address a specific condition.
7. A patient undergoes a limited pharyngectomy to remove a pharyngeal lesion that involves the removal of the thyroid ala, hyoid bone, and wall of the piriform fossa.