Summary & Overview
CPT 31390: Pharyngolaryngectomy (Removal of Pharynx and Larynx)
CPT code 31390 represents a major head and neck surgical procedure: pharyngolaryngectomy, the combined removal of the pharynx and larynx without reconstruction. Nationally, this code captures high-acuity surgical care typically delivered in hospital operating rooms for patients with severe swallowing dysfunction or advanced disease affecting the upper aerodigestive tract. The procedure has important implications for resource use, care coordination, and post-operative rehabilitation needs.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and coding scope, expected site-of-service considerations, and the common modifiers associated with reporting this surgical service. The publication outlines benchmarks and policy considerations relevant to national payers and provides clarity on the clinical intent of the code—removal of pharynx and larynx without reconstruction. When applicable, the piece highlights implications for billing, care setting, and documentation that affect reimbursement and utilization tracking.
Data not provided in the input—such as associated taxonomies, specific ICD-10 diagnosis pairings, and related codes—is noted as unavailable. The content is intended to orient clinicians, coders, and payers to the clinical meaning and coding boundaries of CPT code 31390 at a national level.
Billing Code Overview
CPT code 31390 describes a pharyngolaryngectomy, a surgical procedure in which the provider removes the pharynx and larynx. This operation is typically performed for patients with severe disease causing impaired swallowing or airway compromise where removal of both the pharyngeal and laryngeal structures is indicated. The code description specifies that reconstruction is not included under this code.
Service type: Surgical, head and neck procedure
Typical site of service: Inpatient hospital operating room or other hospital surgical settings where major head and neck resections are performed.
Clinical & Coding Specifications
Clinical Context
A 64-year-old male with a history of recurrent squamous cell carcinoma of the hypopharynx presents with progressive dysphagia, aspiration, and airway compromise despite prior radiotherapy. After multidisciplinary tumor board review, the otolaryngology–head and neck surgical team schedules a pharyngolaryngectomy for definitive oncologic control and to address life-threatening swallowing and airway dysfunction. Preoperative workup includes cross-sectional imaging (CT/MRI) to define tumor extent, endoscopic evaluation, anesthesia assessment, and discussion of potential need for staged reconstruction. The procedure is performed in an operating room under general endotracheal anesthesia with the patient supine. The surgeon removes the larynx and involved pharyngeal segments; reconstruction is not performed during this coded service. Postoperative care occurs in a monitored inpatient setting with enteral nutrition planning, tracheostomy management, and coordination with speech-language pathology for swallowing rehabilitation and stoma care. Billing reflects primary operative CPT code 31390, with additional documentation for extent of resection, intraoperative findings, and any staged reconstructive plan.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than usual (e.g., extensive tumor burden requiring longer operative time and complexity). |