2025 CPT code 42509
Parotid duct diversion, bilateral (Wilke type procedure); with excision of both submandibular glands.
Medical necessity for this procedure is established when excessive drooling significantly impacts a patient's health, well-being, or daily functioning, and conservative management has failed. Documentation supporting the functional impairment caused by the sialorrhea is essential.
The surgeon performs the procedure under general anesthesia, making incisions in the mouth and neck to access the glands and ducts. They carefully dissect the glands and reroute the ducts, taking precautions to avoid damage to surrounding nerves and blood vessels.
In simple words: The surgeon redirects the saliva ducts located near the ears and removes the salivary glands under the jaw to reduce drooling.
This procedure involves rerouting the parotid ducts (which carry saliva from the parotid glands) and removing both submandibular salivary glands. It's typically done to address excessive drooling (sialorrhea).
Example 1: A child with cerebral palsy experiences severe drooling that interferes with their daily activities and oral hygiene. The Wilke procedure is performed to manage the drooling and improve their quality of life., An adult with Parkinson's disease develops sialorrhea, causing social embarrassment and difficulty swallowing. The procedure is recommended to alleviate these symptoms., A patient post-stroke experiences excessive drooling. After conservative treatments fail, the Wilke procedure is considered to manage the sialorrhea.
Documentation should include details about the severity of the sialorrhea, any prior treatments attempted, and the medical necessity of the procedure. Operative notes should describe the surgical technique used, any complications encountered, and post-operative instructions.
- Specialties:Otolaryngology, Oral and Maxillofacial Surgery, Plastic Surgery
- Place of Service:Ambulatory Surgical Center, Inpatient Hospital, Outpatient Hospital