Summary & Overview
CPT 42310: Incision and Drainage of Submaxillary/Sublingual Salivary Gland Abscess
CPT code 42310 denotes an intraoral surgical incision and drainage of an abscess involving the submaxillary (submandibular) or sublingual salivary gland. This procedure addresses acute infections that produce fluctuance and pus collection under the oral mucosa, and it has implications for both acute care surgical services and outpatient otolaryngology or oral and maxillofacial practice. Nationally, accurate coding for this procedure ensures appropriate tracking of surgical utilization, resource planning for operating rooms and procedural suites, and alignment with payer policies for surgical drainage procedures.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and typical settings for the service, a summary of common billing modifiers reported with this code, and guidance on what information is available versus not provided in the input. The publication also highlights benchmarking and policy-relevant topics readers can expect, such as billing frequency, typical sites of service, and payer coverage considerations at a national level. Data not available in the input are clearly noted, including specific ICD-10 diagnosis pairings, associated taxonomies, and related procedure codes.
Billing Code Overview
CPT code 42310 describes a surgical procedure in which a provider makes an incision in the mouth to drain an abscess of the submaxillary or sublingual salivary gland. This procedure is a surgical incision and drainage of a salivary gland abscess performed intraorally.
-
Service type: Surgical incision and drainage
-
Typical site of service: Intraoral procedure, commonly performed in an operating room, procedure room, or clinic setting with appropriate sterile technique and anesthesia support
Clinical & Coding Specifications
Clinical Context
A 52-year-old male presents to the oral and maxillofacial clinic with a 3-day history of progressive, painful swelling and induration under the tongue and along the floor of mouth, difficulty swallowing, and malaise. On exam there is fluctuant sublingual swelling with erythema and pooling of purulent material at the ductal opening; the patient is febrile and reports difficulty advancing solid foods. Point-of-care ultrasound confirms a well-defined fluid collection consistent with a salivary gland abscess. After informed consent, the patient is taken to a procedure room where the provider performs an intraoral incision and drainage of the sublingual/submaxillary salivary gland abscess under local anesthesia with conscious sedation as needed. Purulent material is cultured; hemostasis is achieved and a small drain or packing is left in place when indicated. The patient is given post-procedure wound care instructions, oral antibiotics based on culture or empiric coverage, and arranged for short-term follow-up to reassess healing and remove packing if present.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, routine service | Use when the procedure is performed under routine circumstances without complications or unusual circumstances. |
22 |