🔪 CPT 31367 — Laryngectomy; Subtotal Supraglottic, Without Radical Neck Dissection
Quick Reference
wRVU: 29.81¹ | Global Period: 090 | Assistant Payable: Yes | Bilateral Indicator: 0 Rule: CPT 31367 carries a bilateral indicator of 0 because the larynx is a single midline structure, so modifier -50 is never appropriate. This code is distinguished from 31365 and 31368 by the absence of a radical neck dissection — if nodal disease requires dissection, 31368 or a separately reportable 38724 applies instead². Because only the supraglottic structures are removed, true vocal fold function and airway continuity are typically preserved, unlike total laryngectomy codes.
📋 Clinical Description
CPT 31367 describes a subtotal laryngectomy limited to the supraglottic region — removing the epiglottis, false vocal folds, and aryepiglottic folds — while preserving the true vocal folds and cricoid cartilage. This voice- and airway-sparing approach is reserved for early-stage (T1-T2) supraglottic carcinoma without clinical or radiographic evidence of nodal metastasis, distinguishing it from 31368 (the same resection performed with a radical neck dissection when nodal disease is present).
Unlike 31365 (total laryngectomy with radical neck dissection), which permanently eliminates natural voice and requires a stoma, 31367 preserves glottic function so most patients retain the ability to phonate and swallow with rehabilitation. Compared to 31300 (laryngotomy with tumor removal), which is a more limited excisional procedure, 31367 represents a more extensive organ-preserving resection of an entire laryngeal subsite.
Clinical contexts:
- Early-stage (T1-T2) supraglottic squamous cell carcinoma without nodal involvement.
- Cases where organ preservation and voice retention are surgical priorities.
- Recurrent or persistent supraglottic disease after radiation failure, when nodal status remains negative.
- Extension of disease from the epiglottis into adjacent supraglottic structures without deep invasion.
- Staged procedures following prior diagnostic laryngoscopy confirming resectable, node-negative supraglottic tumor.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Supraglottic Resection | The surgeon removes the epiglottis, aryepiglottic folds, and false vocal folds via an external or transoral approach, preserving the true vocal folds and arytenoids whenever oncologically feasible. | Preservation of at least one functioning arytenoid is critical to maintaining postoperative swallowing and airway protection. |
| Airway Management | A temporary tracheostomy is often placed to protect the airway during postoperative edema resolution, but unlike total laryngectomy, this is typically reversible. | The temporary tracheostomy is distinct from the permanent stoma required in 31365 and 31360. |
| Swallowing Rehabilitation | Postoperative swallowing therapy addresses the altered laryngeal closure mechanism, since the epiglottis normally directs the bolus around the airway during swallowing. | Aspiration risk is a major postoperative concern and often requires formal swallow evaluation before oral intake resumes. |
Clinical Pearl
✅ Procedure Includes
- Resection of the epiglottis and aryepiglottic folds.
- Resection of the false vocal folds (supraglottic structures).
- Preservation of the true vocal folds and at least one arytenoid when oncologically appropriate.
- Temporary tracheostomy placement for airway protection during recovery.
- Primary closure or reconstruction of the supraglottic defect.
- Intraoperative frozen section margin assessment.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 31368 | Laryngectomy; subtotal supraglottic, with radical neck dissection | Used instead of 31367 when a radical neck dissection is performed concurrently for nodal disease. |
| 31365 | Laryngectomy; total, with radical neck dissection | Represents a total (not subtotal) laryngectomy; mutually exclusive since only one laryngectomy extent is billed per larynx. |
| 31360 | Laryngectomy; total, without radical neck dissection | A total, not subtotal, resection; not reported together with 31367 for the same larynx. |
| 38724 | Cervical lymphadenectomy (modified radical neck dissection) | May be separately reported with modifier -59 if a modified (non-radical) neck dissection is performed alongside 31367 for staging purposes. |
Bundling Alert
The 090-day global period bundles routine postoperative visits, swallow evaluations tied directly to the surgical recovery, and wound checks within 90 days. If a separate, unplanned return to the OR is needed for airway compromise or bleeding, modifier -78 applies. Audit risk increases when 31367 is billed but the operative note actually describes glottic or subglottic extension, which would require a different code.
🌳 Code Tree — Surgery: Larynx
CPT 31300-31599 Surgery: Larynx
│
├── 31300-31320 Laryngotomy/Laryngostomy
│ ├── 31300 Laryngotomy, with removal of tumor, laryngocele, or web
│ └── 31320 Laryngotomy, diagnostic
│
├── 31360-31382 Excision (Larynx)
│ ├── 31360 Laryngectomy; total, without radical neck dissection
│ ├── 31365 Laryngectomy; total, with radical neck dissection
│ ├── ▶▶ 31367 ◀◀ Laryngectomy; subtotal supraglottic, without radical neck dissection ← YOU ARE HERE (Global: 090)
│ └── 31368 Laryngectomy; subtotal supraglottic, with radical neck dissection
│
└── 31390-31395 Pharyngolaryngectomy
├── 31390 Pharyngolaryngectomy, with radical neck dissection; without reconstruction
└── 31395 Pharyngolaryngectomy, with radical neck dissection; with reconstruction💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 29.81¹ |
| Global Period | 090 |
| Bilateral Indicator | 0 |
| Assistant Surgeon | Payable |
| Co-Surgeon | Payable with documentation |
| Team Surgery | Not typically applicable |
| PC/TC Split | 0 |
| Modifier -51 Exempt | No |
| Anesthesia | General; billed separately |
Bilateral Billing Rules
Modifier -50 is never appropriate for 31367 because the larynx is a single midline structure and the procedure inherently addresses the entire supraglottic region, not a paired anatomic site. There is no laterality concept for this code since it does not involve a neck dissection component. Any concurrent nodal sampling should be evaluated for separate reporting under 38724 rather than treated as a bilateral variant of 31367.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -22 | Increased Procedural Services | For cases with unusually extensive supraglottic involvement or difficult reconstruction requiring substantially more work than typical. |
| -62 | Two Surgeons | When two surgeons of different specialties each perform a distinct portion (e.g., ENT resection plus separate reconstructive closure). |
| -80 | Assistant Surgeon | When a second physician actively assists throughout the resection. |
| -AS | PA/NP/CNS Assistant at Surgery | When a non-physician practitioner serves as the surgical assistant. |
| -58 | Staged/Related Procedure | When a planned staged procedure (e.g., completion resection or delayed reconstruction) is performed within the global period. |
🩺 Common ICD‑10‑CM Pairings
Primary Diagnosis Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| C32.1 | Malignant neoplasm of supraglottis | Yes | The primary and most direct indication for 31367; documents the specific laryngeal subsite. |
| C10.1 | Malignant neoplasm of anterior surface of epiglottis | Yes | Used when the tumor is centered on the epiglottis itself, which is a supraglottic structure. |
| C32.8 | Malignant neoplasm of overlapping sites of larynx | Yes | Used when the tumor spans supraglottic and adjacent subsites without a single clear site of origin. |
Secondary Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| R13.10 | Dysphagia, unspecified | No | Common preoperative symptom supporting medical necessity; refine with specificity if documented. |
| R49.0 | Dysphonia | No | May support preoperative workup documentation but is not the definitive surgical diagnosis. |
Etiology / Complication
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| J38.3 | Other diseases of vocal cords | No | Reported if a postoperative vocal fold complication arises within the global period. |
| T81.4XXA | Infection following a procedure, initial encounter | No | Reported if a postoperative surgical site infection develops within the global period. |
Coding Specificity Reminder
Always code to the specific supraglottic subsite documented (epiglottis, aryepiglottic fold, false vocal fold) rather than defaulting to an unspecified or overlapping code when pathology supports greater specificity**. Never report a parent category code alone** — C32 and C10 always require additional characters to be billable. Confirm the pathology report and operative note agree on tumor origin before finalizing the diagnosis code.
🏥 MS‑DRG Considerations
Inpatient 31367 typically groups to DRG 129, 130, or 131 (Major Head and Neck Procedures with MCC, with CC, or without CC/MCC) depending on grouper version and comorbidity capture. Because this procedure is more function-preserving than total laryngectomy, postoperative complications tend to center on aspiration and airway edema rather than permanent stoma-related issues, and accurate capture of aspiration pneumonia or acute respiratory failure as secondary diagnoses can affect DRG weighting.
🔧 ICD‑10‑PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
| 0CBS0ZZ | Excision of larynx, open approach | Open partial resection of laryngeal structures |
| 0CBS4ZZ | Excision of larynx, percutaneous endoscopic approach | Minimally invasive partial resection |
| 0CB50ZZ | Excision of epiglottis, open approach | Targeted epiglottic excision component |
| 0CB60ZZ | Excision of larynx, open approach (alternate qualifier) | Additional supraglottic tissue excision |
PCS Character Analysis
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical section. |
| 2 | Body System | C | Respiratory system. |
| 3 | Root Operation | B | Excision — cutting out a portion of a body part without replacement, matching subtotal resection. |
| 4 | Body Part | S | Larynx (supraglottic subdivision). |
| 5 | Approach | 0 | Open approach, the standard technique for this resection. |
| 6 | Device | Z | No device placed during the excision. |
| 7 | Qualifier | Z | No qualifier needed. |
Root Operation Comparison
Excision (B) is used here rather than Resection (T) because only a portion of the larynx — the supraglottic structures — is removed, not the entire organ. This directly contrasts with total laryngectomy codes, which use Resection (T) since the entire larynx is removed. Coders should never use Resection (T) for 31367 in PCS coding, since that would misrepresent the extent of the procedure.
📝 Coding Examples
Example 1
Clinical Scenario: A 61-year-old male with T2N0 squamous cell carcinoma of the supraglottis undergoes subtotal supraglottic laryngectomy with preservation of both true vocal folds and one arytenoid. No neck dissection is performed since imaging and clinical exam show no nodal disease. A temporary tracheostomy is placed for airway protection during recovery.
| Field | Code | Rationale |
|---|---|---|
| CPT | 31367 | Captures the supraglottic resection without neck dissection, matching the node-negative status. |
| PDx | C32.1 | Documents the supraglottic subsite as the primary malignant diagnosis. |
Note
Confirm imaging and clinical staging support N0 status in the documentation, since any nodal involvement would shift coding to 31368 instead.
Example 2
Clinical Scenario: A 58-year-old female with T1 epiglottic carcinoma undergoes subtotal supraglottic laryngectomy limited to the epiglottis and aryepiglottic folds, with primary closure and no neck dissection. Postoperative course is complicated by mild aspiration requiring swallow therapy.
| Field | Code | Rationale |
|---|---|---|
| CPT | 31367 | Reflects the subtotal supraglottic resection performed without radical neck dissection. |
| PDx | C10.1 | Documents the epiglottis as the specific tumor origin site. |
Note
Postoperative aspiration and swallow therapy within the global period are bundled and not separately billable unless a distinct, unrelated diagnosis is documented.
Example 3
Clinical Scenario: A 66-year-old male undergoes subtotal supraglottic laryngectomy for recurrent supraglottic carcinoma after prior radiation failure. Ten days postoperatively, within the global period, he returns to the OR for planned removal of the temporary tracheostomy tube and closure of the tracheostoma site.
| Field | Code | Rationale |
|---|---|---|
| CPT | 31367 | Reports the original index supraglottic resection. |
| PDx | C32.1 | Captures the primary supraglottic malignancy diagnosis for the index surgery. |
Global period reminder
The planned tracheostomy closure is a staged, related procedure and should be reported with modifier -58 rather than treated as a new, unrelated encounter.
⚠️ Common Coding Pitfalls
- Reporting 31367 when the operative note actually describes a radical neck dissection, which requires 31368 instead².
- Reporting 31367 when the resection extends into the glottis or subglottis, which would require a different, more extensive code.
- Defaulting to an unspecified or overlapping diagnosis code when the pathology report documents a specific supraglottic subsite.
- Failing to append modifier -58 for planned staged procedures (such as tracheostomy closure) performed within the global period.
- Separately billing routine postoperative swallow evaluations directly tied to expected surgical recovery within the global period.
- Confusing 31367 with 31300 (laryngotomy with tumor removal), which is a far more limited excisional procedure and not equivalent to a subtotal laryngectomy.
**Sources:** 1. medicalfeeschedules.com. "CPT 31367 Medicare reimbursement rate: $1,921.89 (Q3 2026)." 2026. 2. AAPC. "CPT Code 31367 - Excision Procedures on the Larynx." AAPC Codify, 2026 code changes reviewed. 3. ENT UK/AAO-HNS. "Clinical Indicators: Laryngectomy." Reference for supraglottic laryngectomy clinical criteria.