Summary & Overview
CPT 31365: Laryngectomy with Radical Neck Dissection
CPT code 31365 denotes a laryngectomy performed concurrently with a radical neck dissection, a major head and neck oncologic surgery that removes the voice box and regional lymphatic tissue. This procedure is clinically significant because it addresses both primary laryngeal disease and potential or confirmed regional metastasis, and it commonly requires inpatient care, multidisciplinary teams, and extended perioperative resources. Nationally, such procedures factor into surgical oncology volumes, hospital resource planning, and bundled-payment considerations.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent and setting for CPT code 31365, benchmarks and reimbursement context where available, and discussion of policy and coding considerations relevant to surgical head and neck oncology. The publication outlines clinical context, expected site of service, and common billing modifiers (list provided separately), and it highlights areas where coding clarity and documentation affect payment and utilization measurement. Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and related procedure codes are noted as unavailable.
Billing Code Overview
CPT code 31365 describes a surgical procedure in which the provider performs a laryngectomy (removal of the larynx) combined with a radical neck dissection involving removal of lymph nodes and adjacent tissues. This code represents an extensive head and neck cancer surgery that addresses both the primary tumor in the larynx and regional nodal disease.
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Service type: Surgical resection of the larynx with radical neck dissection
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Typical site of service: Hospital operating room (inpatient surgical setting)
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old male with a history of tobacco and alcohol use who presents with progressive hoarseness, dysphagia, and an enlarging neck mass. Biopsy of a supraglottic/laryngeal lesion returns invasive squamous cell carcinoma with radiographic evidence of ipsilateral cervical nodal metastasis. After multidisciplinary tumor board discussion, the treatment plan is surgical: total laryngectomy with radical neck dissection to remove the primary tumor and involved lymphatic drainage.
Preoperative workflow includes airway assessment, cross-sectional imaging (CT or MRI of the neck and chest), fiberoptic laryngoscopy, preoperative anesthetic evaluation, and informed consent documenting risks including permanent tracheostomy and loss of natural voice. Intraoperative steps include general endotracheal anesthesia, incision and en bloc removal of the larynx with appropriate margins, selective or modified radical neck dissection depending on nodal involvement, hemostasis, placement of a permanent tracheostomy, and reconstruction as indicated (primary closure or regional/free flap). Postoperative care occurs in the intensive care unit or step-down unit with airway monitoring, wound care, nutritional support (enteral feeding tube), and early speech-language pathology consultation for alaryngeal voice rehabilitation and stoma care education. Oncology coordination for adjuvant radiation and/or chemotherapy is arranged based on final pathology.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier |