42410

🧬 CPT 42410 — Excision of Parotid Tumor or Parotid Gland; Lateral Lobe, Without Nerve Dissection

📋 Code Information

Field	Value
CPT Code	42410
Descriptor	Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection
Section	Salivary Gland and Duct Procedures (42300-42699)
Approach	Open surgical
Global Period	090 days (Major Surgical Package)
Global Breakdown	Pre-op: 9% | Intra-op: 81% | Post-op: 10%
Bilateral Indicator	0 (150% bilateral adjustment does not apply)
Assistant Surgeon	Indicator 2 (Payment restriction does not apply; assistant allowed)
Co-Surgeon	Indicator 1 (Co-surgeons allowed with medical necessity documentation)
Team Surgery	Indicator 0 (Team surgery not permitted)
Effective Date	1990 (approx.)
Status / Year	Active ✅ (2026 CMS PFS)

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📖 Clinical Description

CPT 42410 describes a surgical procedure to remove a tumor from the lateral (superficial) lobe of the parotid gland or to excise the lateral lobe itself, specifically without dissection of the facial nerve (cranial nerve VII). The parotid gland is the largest of the major paired salivary glands, situated anteroinferior to the external auditory canal and extending over the masseter muscle.

Anatomical Context

The parotid gland is anatomically divided into two portions by the branching path of the facial nerve:

• Lateral (Superficial) Lobe: The larger superficial portion overlying the masseter muscle and ascending ramus of the mandible.
• Medial (Deep) Lobe: The deeper portion extending medial to the facial nerve into the parapharyngeal space.

The main trunk of the facial nerve exits the stylomastoid foramen and enters the posterior substance of the parotid gland, branching into the temporofacial and cervicofacial trunks and ultimately five terminal branches (temporal, zygomatic, buccal, marginal mandibular, and cervical).

Surgical Procedure Steps

1. Incision: A modified Blair or standard preauricular/cervical parotidectomy incision is made anterior to the auricle, curving around the ear lobule and extending into a natural cervical skin crease.
2. Flap Elevation: A superficial musculoaponeurotic system (SMAS) / skin flap is elevated anteriorly to expose the lateral parotid capsule.
3. Mobilization: The anterior and inferior margins of the lateral lobe are freed from the sternocleidomastoid muscle and posterior belly of the digastric muscle.
4. Facial Nerve Identification: The main trunk or landmark of the facial nerve is identified for protection. Key for 42410: While the main trunk may be identified to avoid injury, this code specifies “without nerve dissection”—meaning the operating surgeon does not formally dissect, trace, or skeletonize the individual branches of the facial nerve.
5. Lobe/Tumor Excision: The lateral lobe or tumor within the superficial gland is excised with appropriate margins.
6. Hemostasis & Drainage: Hemostasis is achieved with bipolar electrocautery or suture ligatures. A closed suction drain is placed through a separate stab incision.
7. Closure: Layered anatomical closure of the parotid bed, subcutaneous tissues, and skin.

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🔍 Clinical Indications & Medical Necessity

• Benign parotid neoplasms (e.g., pleomorphic adenoma, Warthin tumor) located strictly within the superficial substance.
• Low-grade malignant neoplasms (e.g., low-grade mucoepidermoid carcinoma) when peripheral and superficial.
• Chronic recurrent sialadenitis or parotitis unresponsive to conservative medical therapy or sialendoscopy.
• Sialolithiasis of the intraglandular parotid duct system not amenable to endoscopic or transoral extraction.
• Parotid cysts / lymphoepithelial lesions requiring definitive surgical excision.

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🔍 Includes vs. Excludes

Includes (Bundled Services)

• Incision, local tissue elevation, and lateral lobe tumor resection.
• Identification and basic preservation of the main facial nerve trunk without branch tracing.
• Routine intraoperative nerve stimulation / monitoring performed by the operating surgeon.
• Hemostasis, drain placement, and layered wound closure.
• Pre-operative workup on the day before/day of surgery and 90 days of routine post-operative care.

Excludes & Differentiating Codes

Code	Description	Clinical Distinction
42410	Lateral lobe, without nerve dissection	Minimal nerve identification only; no branch dissection
42415	Lateral lobe, with dissection and preservation of facial nerve	Formal dissection and skeletonization of CN VII branches
42420	Total parotidectomy, with nerve preservation	Resection of superficial AND deep lobes with nerve preservation
42425	Total parotidectomy, en bloc with nerve sacrifice	Complete gland removal with sacrifice of facial nerve (malignancy)
42426	Total parotidectomy, with nerve sacrifice and nerve graft	Total parotidectomy with sacrifice of CN VII + immediate nerve grafting
42400	Biopsy of salivary gland, needle	Diagnostic needle biopsy (not open excision)
42405	Biopsy of salivary gland, incisional	Diagnostic tissue wedge removal without therapeutic lobectomy
42440	Excision of submandibular gland	Submandibular gland resection (different anatomical organ)
42450	Excision of sublingual gland	Sublingual gland resection (different anatomical organ)

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📊 Code Hierarchy

flowchart TD
    A["42300-42699 Salivary Gland and Duct Procedures"] --> B["Incision and Drainage (42300-42340)"]
    A --> C["Biopsy Procedures (42400-42405)"]
    A --> D["Excision Procedures - Parotid Gland"]
    
    D --> E["42410 Lateral lobe, WITHOUT nerve dissection"]
    D --> F["42415 Lateral lobe, WITH nerve dissection and preservation"]
    D --> G["42420 Total parotidectomy, WITH nerve preservation"]
    D --> H["42425 Total parotidectomy, en bloc WITH nerve sacrifice"]
    D --> I["42426 Total parotidectomy, WITH nerve sacrifice & nerve graft"]
    
    A --> J["Excision Procedures - Other Salivary Glands"]
    J --> K["42408 Ranula excision"]
    J --> L["42440 Submandibular gland excision"]
    J --> M["42450 Sublingual gland excision"]

    style E fill:#2B6CB0,stroke:#1A365D,stroke-width:2px,color:white

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💰 2026 CMS Reimbursement & RVU Breakdown

Under the 2026 Medicare Physician Fee Schedule (PFS PPR RVU 2026):

RVU / Payment Component	Facility Value	Non-Facility Value	Notes / CMS Regulation
Work RVU (wRVU)	9.33	9.33	Physician intra-service work
Practice Expense (PE) RVU	5.90	NA	Facility overhead expense
Malpractice (MP) RVU	1.45	1.45	Professional liability component
Total RVU	16.68	NA	Standard facility total
2026 Non-QPP Conversion Factor	$33.4009	$33.4009	Base Medicare payment factor
Estimated National Medicare Base	~$557.13	NA	Geographic GPCI adjustments apply

2026 Fee Schedule Note

CMS implemented a 2.5% productivity/efficiency adjustment across non-time-based surgical codes in the 2026 PFS. Payment amounts shown reflect the 2026 unadjusted national rate.

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🔄 Modifiers and Billing Guidelines

Common Modifiers for CPT 42410

Modifier	Description	Practical Application & Guidelines
-LT / -RT	Left / Right Laterality	Report to specify laterality of the affected parotid gland.
-22	Increased Procedural Services	Used when work required is substantially greater than typical (e.g., severe scarring from prior surgery, extreme tumor adhesion). Operative report must detail specific reasons and extra time/effort (>50%).
-50	Bilateral Procedure	CMS Bilateral Indicator 0: 150% bilateral adjustment does not apply under Medicare. If bilateral parotidectomy is performed, bill two separate lines with modifiers -RT and -LT (or check specific commercial payer contracts).
-51	Multiple Procedures	Append to secondary procedures performed during the same operative session (e.g., neck dissection 38720 or 38724).
-52	Reduced Services	Append if lateral lobectomy is partially reduced at the physician’s discretion.
-53	Discontinued Procedure	Append if procedure is terminated after anesthesia induction due to extenuating circumstances or patient instability.
-58	Staged / Related Procedure	Append if a planned or staged re-excision is performed during the 90-day global period.
-59 / -X{EPSU}	Distinct Procedural Service	Used to unbundle independent, non-overlapping surgical procedures performed in a distinct anatomical area.
-78	Unplanned Return to OR	Append for complications requiring return to the operating room during the 90-day global period (e.g., post-operative hematoma evacuation).
-79	Unrelated Procedure in Global	Append for unrelated procedures performed by the same surgeon during the 90-day global period.
-80 / -82 / -AS	Assistant at Surgery	Assistant Indicator 2: Payment restriction does not apply; assistant surgeon (-80), non-available resident (-82), or PA/NP assistant (-AS) is payable when documentation supports medical necessity.
-62	Two Surgeons (Co-Surgery)	Co-Surgeon Indicator 1: Allowed when two distinct surgical specialists (e.g., ENT and Neurotologist) act as co-surgeons; documentation of distinct operative roles is required.

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⚡ Intraoperative Neurophysiology Monitoring (IONM) Rules

• Surgeon-Performed Monitoring: When the primary surgeon operates the nerve stimulator or monitors the facial nerve, the service is integral to CPT 42410 and cannot be billed separately.
• Independent Monitoring Professional (Neurologist / PhD Neurophysiologist):
  • In-Person Attendance in OR: May bill add-on code +95940 (Continuous intraoperative neurophysiology monitoring in the OR, per 15 min) in conjunction with primary baseline testing codes (e.g., 95867-95868 or 95925-95937).
  • Remote / Outside the OR (Medicare Policy): Under CMS rules, monitoring from outside the OR must be billed with HCPCS code G0453 (Intraoperative neurophysiology monitoring from outside the OR, per patient, per 15 minutes), capped at allowable concurrent cases.

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📋 Critical Documentation Elements

To ensure audit-proof documentation and prevent downcoding or claim denials:

1. Specific Anatomic Site: Explicitly specify the parotid gland and designate laterality (right vs. left).
2. Extent of Resection: Clearly state lateral (superficial) lobe excision.
3. Nerve Management Statement: Explicitly document facial nerve handling. For 42410, documentation should state that the facial nerve was identified and protected, but no formal branch dissection or skeletonization was required.
4. Pathology Correlation: Correlate pre-op findings with final histopathologic examination for definitive diagnosis coding.
5. Wound Closure & Drains: Document layered closure and placement of suction drains.

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📊 ICD-10-CM & HCC Risk Adjustment Crosswalk

Common Primary Diagnoses

ICD-10-CM Code	Description	CMS-HCC V24	CMS-HCC V28 (2026)
C07	Malignant neoplasm of parotid gland	HCC 10	HCC 21
D11.0	Benign neoplasm of parotid gland	Non-HCC	Non-HCC
D11.7	Benign neoplasm of other major salivary glands	Non-HCC	Non-HCC
D11.9	Benign neoplasm of major salivary gland, unspecified	Non-HCC	Non-HCC
D00.02	Carcinoma in situ of parotid gland	Non-HCC	Non-HCC
K11.20	Sialoadenitis, unspecified	Non-HCC	Non-HCC
K11.22	Chronic sialoadenitis	Non-HCC	Non-HCC
K11.23	Parotitis	Non-HCC	Non-HCC
K11.5	Sialolithiasis	Non-HCC	Non-HCC
R22.1	Localized swelling, mass and lump, neck	Non-HCC	Non-HCC
Z85.819	Personal history of malignant neoplasm of oral cavity and pharynx	Non-HCC	Non-HCC

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🏥 Facility & Inpatient Coding (MS-DRG & ICD-10-PCS)

MS-DRG Grouper (MDC 03 — Diseases & Disorders of Ear, Nose, Mouth & Throat)

When reported in the hospital inpatient setting, surgical procedures on the parotid gland group as follows:

MS-DRG	Description	Relative Weight (Approx.)
139	Salivary Gland Procedures	~1.35
146	Ear, Nose, Mouth & Throat Malignancy with MCC	~2.55
147	Ear, Nose, Mouth & Throat Malignancy with CC	~1.50
148	Ear, Nose, Mouth & Throat Malignancy without CC/MCC	~1.05

ICD-10-PCS Procedure Codes

In ICD-10-PCS, lateral (partial) parotidectomy is classified under root operation Excision (B), whereas total parotidectomy is classified under root operation Resection (T):

Procedure	PCS Code	Description
Right Lateral Parotidectomy (Partial)	0GB30ZZ	Excision of Right Parotid Gland, Open Approach
Left Lateral Parotidectomy (Partial)	0GB40ZZ	Excision of Left Parotid Gland, Open Approach
Bilateral Lateral Parotidectomy (Partial)	0GB50ZZ	Excision of Bilateral Parotid Glands, Open Approach
Total Parotidectomy, Right (Reference)	0GTC0ZZ	Resection of Right Parotid Gland, Open Approach
Total Parotidectomy, Left (Reference)	0GTD0ZZ	Resection of Left Parotid Gland, Open Approach

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📝 Practical Coding Scenarios

Scenario 1: Superficial Parotidectomy for Pleomorphic Adenoma

• History: A 52-year-old female presents with a 2.5 cm mobile mass in the right superficial parotid gland. The surgeon excises the lateral lobe; the main facial nerve trunk is visualized and preserved, without dissection of peripheral branches. Final pathology confirms benign pleomorphic adenoma.
• Coding:
  • CPT: 42410-RT
  • ICD-10-CM: D11.0

Scenario 2: Parotid Tumor Involving Extensive Branch Dissection (Coding Distinction)

• History: The surgeon performs a lateral parotidectomy where the tumor is intimately wrapped around the buccal and marginal mandibular branches of CN VII, requiring 45 minutes of microscope-assisted nerve branch dissection to preserve all branches intact.
• Correct Coding:
  • CPT: 42415-LT (Excision of parotid tumor; lateral lobe, with dissection and preservation of facial nerve)
  • ICD-10-CM: D11.0
  • Rationale: Because the nerve branches were actively dissected and preserved, 42415 must be reported rather than 42410.

Scenario 3: Return to OR for Post-Operative Bleeding

• History: On post-operative day 1 following right superficial parotidectomy, the patient develops an expanding wound hematoma requiring urgent return to the operating room for surgical evacuation and control of bleeding.
• Coding:
  • CPT: 42410-RT-78 (or 35800-78 depending on payer preference)
  • ICD-10-CM: T81.0XXA (Hemorrhage and hematoma complicating a procedure)

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🔗 Related Specialty & CPT Codes

• 42415 — Excision of parotid tumor or parotid gland; lateral lobe, with dissection and preservation of facial nerve
• 42420 — Excision of parotid tumor or parotid gland; total, with dissection and preservation of facial nerve
• 42425 — Excision of parotid tumor or parotid gland; total, en bloc removal with sacrifice of facial nerve
• 42426 — Excision of parotid tumor or parotid gland; total, with sacrifice of facial nerve and nerve graft
• 38720 — Cervical lymphadenectomy (complete neck dissection)
• 38724 — Cervical lymphadenectomy (modified radical neck dissection)
• 15275-15278 — Application of skin substitute graft to face, scalp, neck
• 95940 / G0453 — Intraoperative neurophysiology monitoring

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📚 References & Regulatory Citations

1. American Medical Association (AMA). CPT 2026 Professional Edition. Salivary Gland and Duct Guidelines.
2. Centers for Medicare & Medicaid Services (CMS). 2026 Medicare Physician Fee Schedule (PFS) Relative Value Files (PPR RVU 2026).
3. CMS National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services (2026), Chapter 8 (Digestive System).
4. AHA Coding Clinic for ICD-10-CM/PCS, Root Operation Excision vs. Resection Guidelines.
5. American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS). Coding and Practice Guidelines for Salivary Gland Surgery.