🔪 CPT 41140 — Glossectomy; Complete or Total, Without Radical Neck Dissection
Quick Reference
wRVU: 57.70¹ | Global Period: 090 | Assistant Payable: Yes | Bilateral Indicator: 0 Rule: CPT 41140 carries a bilateral indicator of 0 because the tongue is a single midline structure, so modifier -50 is never appropriate. This code explicitly excludes radical neck dissection — if nodal disease requires dissection, a combined code or separately reportable 38724 applies instead². A tracheostomy performed as part of the same operative session for airway protection is bundled into this code and not separately billable.
📋 Clinical Description
CPT 41140 describes complete removal of the entire tongue, most often performed to treat malignant tumors of the tongue that have progressed beyond the point where a partial glossectomy would achieve adequate margins. The procedure may include a protective tracheostomy to secure the airway postoperatively, but does not include a radical neck dissection, distinguishing it from head and neck cancer surgeries that combine glossectomy with cervical lymphadenectomy in a single session.
Compared to partial glossectomy codes, which remove only a portion of the tongue and are used for smaller, more localized lesions, 41140 represents a far more extensive resection with significant functional consequences for speech and swallowing. It is also distinguished from composite resection codes that combine glossectomy with mandibulectomy or other adjacent structure removal, since 41140 addresses the tongue alone.
Clinical contexts:
- Advanced (T3-T4) squamous cell carcinoma of the tongue requiring complete removal to achieve adequate surgical margins.
- Extensive tongue malignancy without clinical or radiographic evidence of cervical nodal metastasis, avoiding the need for concurrent neck dissection.
- Recurrent tongue cancer after prior partial glossectomy or radiation failure, requiring completion total glossectomy.
- Severe tongue necrosis or extensive benign disease rarely necessitating complete removal.
- Staged reconstructive planning where total glossectomy is performed first, followed by delayed flap reconstruction in a subsequent session.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Complete Glossectomy | The surgeon removes the entire tongue, including the base, body, and tip, typically through a transoral or combined transoral-transcervical approach depending on tumor extent. | Margin assessment via intraoperative frozen section is critical, since inadequate margins significantly increase recurrence risk. |
| Tracheostomy Component | A protective tracheostomy is often placed to secure the airway during postoperative swelling, since the tongue plays a major role in maintaining airway patency. | The tracheostomy is bundled into 41140 when performed at the same session and is not separately billable. |
| Reconstruction Considerations | While not included in 41140 itself, most patients require free flap or pedicled flap reconstruction to restore some oral function and facilitate swallowing rehabilitation. | Flap reconstruction codes (e.g., 15756) are separately reportable when performed by the same or a different surgeon. |
Clinical Pearl
Confirm the operative note documents complete removal of the entire tongue rather than a subtotal or hemiglossectomy — if any portion of the tongue is intentionally preserved, a partial glossectomy code applies instead of **41140**².
✅ Procedure Includes
- Complete surgical removal of the entire tongue.
- Intraoperative frozen section margin assessment.
- Protective tracheostomy placement, when performed at the same session.
- Hemostasis and closure or preparation of the oral cavity defect for reconstruction.
- Placement of surgical drains when indicated.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 38724 | Cervical lymphadenectomy (modified radical neck dissection) | Separately reportable when a modified radical neck dissection is performed at the same session, since 41140 explicitly excludes radical neck dissection. |
| 41120 | Glossectomy; less than one-half tongue | Represents a partial, not total, resection; mutually exclusive since only one extent of glossectomy is billed per tongue. |
| 41130 | Glossectomy; hemiglossectomy | Also represents a partial resection distinct from the complete removal described by 41140. |
Bundling Alert
The 090-day global period bundles routine postoperative visits, swallow and speech evaluations tied to expected recovery, and wound checks within 90 days. An unplanned return to the OR for flap failure or bleeding requires modifier -78, while a planned staged reconstruction requires modifier -58. Audit risk increases when a radical neck dissection was actually performed but not separately reported, or when 41140 is billed despite documentation supporting only a partial glossectomy.
🌳 Code Tree — Surgery: Tongue and Floor of Mouth
CPT 41000-41599 Surgery: Tongue and Floor of Mouth
│
├── 41000-41019 Incision (Tongue, Floor of Mouth)
│ └── 41000 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; lingual
│
├── 41100-41135 Excision (Tongue, Partial)
│ ├── 41120 Glossectomy; less than one-half tongue
│ └── 41130 Glossectomy; hemiglossectomy
│
├── 41140-41155 Excision (Tongue, Complete/Composite)
│ ├── ▶▶ 41140 ◀◀ Glossectomy; complete or total, with or without tracheostomy, without radical neck dissection ← YOU ARE HERE (Global: 090)
│ ├── 41145 Glossectomy; complete or total, with or without tracheostomy, with unilateral radical neck dissection
│ └── 41150 Glossectomy; composite procedure with resection floor of mouth and mandibular resection, without radical neck dissection
│
└── 41250-41599 Repair / Other Procedures
└── 41250 Repair of tongue, floor of mouth; 2.5 cm or less
💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 57.70¹ |
| Global Period | 090 |
| Bilateral Indicator | 0 |
| Assistant Surgeon | Payable |
| Co-Surgeon | Payable with documentation, particularly when reconstruction is performed by a second surgical team |
| Team Surgery | Applicable when combined with microvascular reconstruction |
| PC/TC Split | 0 |
| Modifier -51 Exempt | No |
| Anesthesia | General; billed separately |
Bilateral Billing Rules
Modifier -50 is never appropriate for 41140 because the tongue is a single midline structure and cannot be resected “bilaterally.” There is no laterality concept for this code since the entire tongue is removed regardless of the laterality of the originating tumor. Any concurrent neck dissection should be evaluated for separate reporting under the appropriate lymphadenectomy code rather than treated as a bilateral variant of 41140.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -22 | Increased Procedural Services | For cases with unusually extensive tumor involvement or difficult reconstruction requiring substantially more operative work than typical. |
| -52 | Reduced Services | When the planned complete glossectomy was modified to a lesser extent than originally intended. |
| -58 | Staged/Related Procedure | When a planned staged reconstruction is performed within the global period of the index glossectomy. |
| -62 | Two Surgeons | When two surgeons of different specialties, such as an ablative head and neck surgeon and a separate microvascular reconstructive surgeon, each perform a distinct portion. |
| -78 | Return to Operating Room | For an unplanned, related return to the OR within the global period, such as for flap failure or bleeding. |
| -79 | Unrelated Procedure | For an unrelated procedure performed by the same surgeon during the global period. |
| -80 | Assistant Surgeon | When a second physician actively assists throughout the resection. |
🩺 Common ICD‑10‑CM Pairings
Primary Diagnosis Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| C02.1 | Malignant neoplasm of border of tongue | Yes | A common primary diagnosis supporting total glossectomy when the tumor originates at the lateral tongue border. |
| C02.9 | Malignant neoplasm of tongue, unspecified | Yes | Should be avoided when subsite documentation is available, since specificity improves both coding accuracy and HCC capture. |
| C04.9 | Malignant neoplasm of floor of mouth, unspecified | Yes | Used when disease extends to or originates from the floor of mouth alongside the tongue involvement. |
Secondary Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| Z93.0 | Tracheostomy status | No | Reported at postoperative encounters reflecting the tracheostomy placed during the glossectomy. |
Etiology / Complication
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| R13.10 | Dysphagia, unspecified | No | Common postoperative symptom supporting ongoing swallowing rehabilitation documentation. |
Coding Specificity Reminder
Always code to the most specific tongue subsite documented in the pathology and operative reports rather than defaulting to C02.9. Never use a parent category code alone — C02 and C04 always require a fourth character to be billable. Confirm the pathology report and operative note agree on tumor extent before finalizing diagnosis code selection.
🏥 MS‑DRG Considerations
Inpatient 41140 typically groups to a major head and neck procedures DRG reflecting the extensive oral cavity resection performed. Because reconstruction is almost always required and postoperative complications commonly include aspiration, wound infection, or flap-related issues, accurate secondary diagnosis capture significantly affects DRG weighting and reflects the true complexity of the admission.
🔧 ICD‑10‑PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
| 0CTS0ZZ | Resection of larynx, open approach | Not applicable to tongue; included here only as a cross-reference for airway-related coding when tracheostomy is also performed |
| 0C9K0ZZ | Drainage of tongue, open approach | May apply if concurrent drainage is performed during the resection |
| 0CBK0ZZ | Excision of tongue, open approach | Represents partial excision component if applicable during staged procedures |
| 0B110F4 | Bypass trachea to cutaneous, open approach, tracheostomy device | Reflects the tracheostomy component performed concurrently with the glossectomy |
PCS Character Analysis
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical section. |
| 2 | Body System | C | Mouth and throat body system, encompassing the tongue. |
| 3 | Root Operation | T | Resection — cutting out all of a body part without replacement, matching total glossectomy. |
| 4 | Body Part | K | Tongue, the specific anatomic structure entirely removed. |
| 5 | Approach | 0 | Open approach, or via natural/artificial opening depending on technique; most total glossectomies use an open or combined approach. |
| 6 | Device | Z | No device, since no implant is placed during the resection itself. |
| 7 | Qualifier | Z | No qualifier needed for the resection component. |
Root Operation Comparison
Resection (T) is used because the entire tongue is removed, unlike Excision (B), which would apply to only a portion of the organ as in a partial glossectomy. The tracheostomy component is coded separately using Bypass (1) since it creates a new airway route rather than removing tissue. Coders should never combine the glossectomy and tracheostomy into a single PCS code — CPT bundles them for professional billing, but PCS always requires separate root operation lines.
📝 Coding Examples
Example 1
Clinical Scenario: A 58-year-old male with T4N0 squamous cell carcinoma of the tongue border undergoes complete glossectomy with protective tracheostomy placement. No cervical lymphadenopathy is identified on imaging or clinical exam, so no neck dissection is performed. Free flap reconstruction is planned as a staged procedure.
| Field | Code | Rationale |
|---|---|---|
| CPT | 41140 | Captures the complete glossectomy with tracheostomy, without radical neck dissection, matching the node-negative status. |
| PDx | C02.1 | Documents the tongue border 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 toward a combined glossectomy-with-neck-dissection code instead.
Example 2
Clinical Scenario: A 65-year-old female with recurrent tongue carcinoma after prior partial glossectomy and radiation undergoes salvage total glossectomy without tracheostomy, since her airway remains stable postoperatively without need for airway protection.
| Field | Code | Rationale |
|---|---|---|
| CPT | 41140 | Reflects the complete glossectomy performed without tracheostomy, since the code descriptor includes “with or without tracheostomy.” |
| PDx | C02.9 | Documents the recurrent tongue malignancy when a more specific subsite is not available in this recurrence setting. |
Note
Document the absence of tracheostomy clearly, since the code still applies regardless, but this affects postoperative airway management documentation.
Example 3
Clinical Scenario: A 50-year-old male undergoes total glossectomy with tracheostomy for advanced tongue cancer. Ten days postoperatively, within the global period, he returns to the OR for a planned staged free flap reconstruction of the resulting oral cavity defect.
| Field | Code | Rationale |
|---|---|---|
| CPT | 41140-58 | Reports the staged reconstruction performed within the global period of the index glossectomy. |
| PDx | C02.1 | Captures the primary tongue border malignancy diagnosis for the index surgery. |
Global period reminder
Modifier -58 is required to indicate the staged, planned nature of the reconstruction and to override the global period bundling edit that would otherwise deny separate payment.
⚠️ Common Coding Pitfalls
- Reporting 41140 when a radical neck dissection was actually performed concurrently, which requires a combined code instead of 41140 alone².
- Using 41140 when the operative note describes only a partial glossectomy or hemiglossectomy, which requires a different, less extensive code.
- Failing to append modifier -58 for a planned staged reconstruction performed within the global period.
- Defaulting to unspecified diagnosis code C02.9 when the pathology report clearly documents a specific tongue subsite.
- Separately billing the tracheostomy performed at the same session, which is bundled into 41140 rather than separately reportable.
- Overlooking documentation of postoperative dysphagia or aspiration risk, which supports the complexity and medical necessity of extensive postoperative rehabilitation services.
**Sources:** 1. gomedicalbilling.com. "CPT 41140: Removal of tongue, 2026 Fee & RVUs." 2026. 2. AAPC. "CPT® Code 41140 - Excision Procedures on the Tongue and Floor of Mouth." AAPC Codify, 2026 code changes reviewed. 3. CDC/NHSN. "CPT-PCM Crosswalk Reference." 2026.