2025 CPT code 31368
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Respiratory System Surgery Feed
Subtotal supraglottic laryngectomy with radical neck dissection.
Modifiers may be applicable depending on the circumstances of the procedure, such as modifier 22 for increased procedural services, modifier 51 for multiple procedures, or other modifiers as per current CPT guidelines.
Medical necessity for a subtotal supraglottic laryngectomy with radical neck dissection is established when a patient is diagnosed with supraglottic cancer that cannot be adequately treated with less invasive modalities such as radiation therapy alone, or when there is evidence of lymph node involvement.
The surgeon is responsible for pre-operative planning, performing the tracheostomy, making the neck incision, carefully dissecting to remove the diseased tissue while preserving important nerves and muscles, and finally closing the wound in layers. Post-operative care and follow up are also part of the clinical responsibility.
In simple words: The surgeon removes the upper part of the voice box and nearby lymph nodes and tissues in the neck to treat cancer or other serious conditions. A temporary breathing tube is placed before surgery.The surgeon works carefully to avoid damaging important nerves and muscles.
This procedure involves the surgical removal of the upper portion of the larynx (supraglottis), including the epiglottis, false vocal cords, and upper half of the thyroid cartilage, along with a radical neck dissection.The radical neck dissection includes the removal of lymph nodes and surrounding tissues, potentially encompassing the sternocleidomastoid muscle, internal jugular vein, submandibular salivary gland, and other neck lymph nodes. A tracheostomy is typically performed prior to the main procedure to ensure airway patency during surgery.Careful attention is given to preserving critical structures such as the muscles above the thyroid gland and the hypoglossal and laryngeal nerves.
Example 1: A 65-year-old male patient presents with a supraglottic laryngeal tumor.Imaging confirms the tumor's location and size, and a biopsy confirms malignancy.A subtotal supraglottic laryngectomy with radical neck dissection (31368) is planned to remove the tumor and affected lymph nodes., A 70-year-old female patient with a history of smoking presents with symptoms consistent with laryngeal cancer. A biopsy confirms the diagnosis. Imaging demonstrates the extent of the disease, involving the supraglottis and regional lymph nodes.A subtotal supraglottic laryngectomy with radical neck dissection (31368) is performed., A 58-year-old male patient is diagnosed with supraglottic cancer. Due to the location and extent of the tumor, a subtotal supraglottic laryngectomy with radical neck dissection (31368) is deemed necessary. The patient is also given adjuvant radiation therapy post-operatively to decrease the recurrence rate.
* Detailed history and physical examination documenting the presence of symptoms indicative of laryngeal cancer.* Preoperative imaging (CT scan, MRI) to delineate the extent of the tumor and involvement of lymph nodes.* Pathology report confirming the diagnosis of malignancy and grading.* Operative report detailing the procedure performed, including the extent of resection and lymph node dissection.* Postoperative pathology report confirming complete resection of the tumor.* Documentation of any complications.
** This procedure is complex and requires careful surgical technique and planning.Accurate coding requires detailed documentation reflecting the extent of the surgical resection and lymph node dissection.
- Revenue Code: P1G (Major Procedure - Other)
- Payment Status: Active
- Modifier TC rule: The application of a technical component (TC) modifier would depend on the individual circumstances of the case, and should be determined per current CPT guidelines.Consult the NCCI edits for any relevant information.
- Specialties:Otolaryngology, Head and Neck Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center