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31390

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🧬CPT 31390 - Pharyngolaryngectomy, with radical neck dissection; without reconstruction

Primary Procedure

  • 31390 - Pharyngolaryngectomy, with radical neck dissection; without reconstruction:

    Detailed Explanation: This is an extensive, morbid surgical procedure performed for advanced head and neck cancers. The surgeon completely removes the larynx (voice box) and a significant portion or all of the pharynx (throat). Additionally, the surgeon performs a radical neck dissection (RND), which involves removing all lymph node groups from levels I through V on one side of the neck, along with three major non-lymphatic structures: the spinal accessory nerve (SAN), the internal jugular vein (IJV), and the sternocleidomastoid muscle (SCM). Crucially, this code indicates the surgeon did not perform the definitive reconstruction (like a gastric pull-up or microvascular free flap) during this specific portion of the procedure.

ICD-10-CM Diagnosis Code(s) (Top 6 Options)

Note: This surgery is almost exclusively performed for advanced-stage malignancies.

  1. C32.9 - Malignant neoplasm of larynx, unspecified: The most common overarching diagnosis, though specific sub-sites (e.g., C32.0 Glottis, C32.1 Supraglottis) should be used if documented.

  2. C13.9 - Malignant neoplasm of hypopharynx, unspecified: Used when the cancer originates in the lower part of the throat, often invading the larynx.

  3. C77.0 - Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck: Must be coded to justify the “radical neck dissection” portion of the procedure if nodes are clinically or pathologically positive.

  4. C14.0 - Malignant neoplasm of pharynx, unspecified: Used when the exact subsite of the pharyngeal tumor cannot be determined.

  5. C32.3 - Malignant neoplasm of laryngeal cartilage: Used for deeply invasive tumors destroying the structural framework of the voice box.

  6. Z85.810 - Personal history of malignant neoplasm of tongue / head and neck: Occasionally used as a secondary code if this is a “salvage” surgery for recurrent disease after primary radiation failure.

CPT/HCPCS Code(s) & Alternatives

The correct code depends entirely on two factors: the extent of the neck dissection and whether reconstruction was performed.

  • 31390 - Pharyngolaryngectomy, with RND; without reconstruction. (Base code for this note).

  • Alternative (With Reconstruction) - 31395: Pharyngolaryngectomy, with radical neck dissection; with reconstruction. (Use this if the same surgeon performs the primary closure/reconstruction using local tissue or specific flaps included in the primary code descriptor).

  • Alternative (Larynx Only) - 31365: Laryngectomy; total, with radical neck dissection. (Use this if the pharynx is largely spared and only the voice box and neck nodes are removed).

  • Alternative (No Neck Dissection) - 31360: Laryngectomy; total, without radical neck dissection.

Global Period

  • 090: This is a major surgical procedure. The global package encompasses the day before surgery, the day of surgery, and 90 days of extensive postoperative care.

Exclusives/Inclusives (Bundling & NCCI Edits)

Inclusives (Commonly Bundled - Do Not Bill Separately)

  • 31600 / 31601 (Tracheostomy): Because the larynx is removed, the airway must be diverted to the neck (permanent tracheostoma). The creation of this airway is strictly bundled into the primary ablative procedure.

  • 60220 / 60240 (Thyroidectomy): Often, the thyroid gland (or half of it) is removed en bloc with the larynx due to tumor proximity. This is generally bundled into the radical laryngectomy codes unless a completely separate, distinct pathology (e.g., a separate contralateral thyroid cancer) is documented.

  • 38510 (Biopsy/Excision of Lymph Nodes): The radical neck dissection encompasses all lymph node removals in that surgical field.

Mutually Exclusives

  • 31395: You cannot bill the “without reconstruction” code and the “with reconstruction” code together.

Assistant Payable

  • Yes: Assistant at surgery (Modifier -80, -82, or -AS) is virtually always required and payable due to the extreme complexity and length of the surgery.

  • Co-Surgery (Modifier -62): Very common. Often, a Head & Neck Oncologic Surgeon performs the ablation (31390), while a Microvascular Plastic Surgeon performs the reconstruction (e.g., 15756 - Free muscle or myocutaneous flap).

Detailed Clinical Context & Documentation Tips (Audit Safeguards)

  • Radical vs. Modified Radical: This is a massive audit trap. To bill 31390 (which specifies a Radical Neck Dissection), the operative note must document the removal of the lymph nodes AND the intentional sacrifice of the Spinal Accessory Nerve, Internal Jugular Vein, and Sternocleidomastoid muscle.

    • Audit Warning: If the surgeon documents “Modified Radical Neck Dissection” (where one or more of those three structures are spared/preserved), you technically cannot bill the standard 31390 without appending Modifier -52 (Reduced Services), as the full anatomical requirements of the CPT descriptor were not met.

  • The Reconstructive Team: If 31390 (without reconstruction) is billed, auditors will look for the reconstructive codes. If a separate surgeon comes in to do a Jejunal Free Flap to rebuild the food tube, the ablative surgeon bills 31390, and the reconstructive surgeon bills the appropriate flap codes (e.g., 43496 or 1575x series).

  • Laterality: If the radical neck dissection is performed on both sides (Bilateral), you should append Modifier -50 (or -RT/-LT depending on payer preference), though bilateral radical neck dissections are extremely rare and morbid; typically, one side is radical and the other is a modified/selective neck dissection (which requires distinct coding like 38724-59).

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