Summary & Overview
CPT 42405: Open Salivary Gland Biopsy with Pathology
Headline: CPT code 42405: Open Salivary Gland Biopsy Sent for Pathology
Lead: CPT code 42405 denotes an open salivary gland biopsy performed through a skin incision directly over the gland with tissue submitted for pathological examination. The code captures a surgical diagnostic procedure used in evaluation of salivary gland masses or unexplained glandular dysfunction.
What the code represents and why it matters: CPT code 42405 documents an operative biopsy of a salivary gland via external incision. This procedure is clinically important because it provides definitive tissue diagnosis for neoplastic, inflammatory, or obstructive salivary gland conditions. Nationally, accurate coding affects claims adjudication, quality reporting, and procedure-level utilization tracking for head and neck surgical services.
Key payers covered: Analysis typically includes major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: Readers will find a concise overview of the clinical context for CPT code 42405, typical sites of service, and the types of benchmarks and policy topics that typically accompany procedural code reviews (reimbursement patterns, documentation requirements, and coding guidance). Data not available in the input for specific reimbursement rates, payer-specific rules, associated taxonomies, and ICD-10 pairings are noted as not provided. The summary is intended for clinicians, billing professionals, and policy analysts seeking a national-level reference for this surgical biopsy code.
Billing Code Overview
CPT code 42405 describes an open surgical procedure in which the provider obtains tissue samples from a salivary gland through a skin incision directly over the gland and sends the specimens for pathological analysis. This service is a salivary gland biopsy via external incision.
Service type: Surgical biopsy / operative procedure
Typical site of service: Operating room or outpatient surgery center, or other procedural settings where minor open head and neck surgery is performed.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents to an outpatient otolaryngology clinic with a palpable, slowly enlarging, firm mass in the region of the parotid gland, intermittent local discomfort, and recent focal facial paresthesia. Imaging with ultrasound or MRI demonstrates a discrete salivary gland lesion suspicious for neoplasm. The patient is scheduled for an excisional or incisional salivary gland biopsy performed under local anesthesia with a small skin incision directly over the gland. The provider obtains representative tissue samples and sends them for histopathological examination, including routine H&E and, if indicated, immunohistochemical stains. Typical workflow: preoperative consent and brief history/physical, marking and sterile preparation of the surgical site, administration of local anesthesia (or monitored anesthesia care if indicated), skin incision and dissection to the salivary gland, tissue sampling (partial excision or core of lesion), hemostasis, layered closure of the incision, postoperative instructions, and specimen submission with pathology requisition.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure required substantially greater work than typical (extensive dissection, prolonged operative time). |
23 |