Summary & Overview
CPT 42426: Total Parotidectomy with Unilateral Radical Neck Dissection
CPT code 42426 represents a combined major head and neck oncology operation: total parotidectomy for a tumor with an ipsilateral radical neck dissection. This code captures extensive ablative surgery used to manage malignant or locally advanced parotid tumors with regional lymphatic involvement. Nationally, the code matters because it denotes high-complexity care with implications for surgical resource use, perioperative risk, and postoperative follow-up.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, typical sites of service, and the payer set applied. The publication provides benchmarks and payment context where available, notes common billing modifiers provided in the input, and summarizes clinical circumstances that generally justify use of the code. It also highlights areas where input data were not provided and lists related administrative details for billing teams.
This summary is intended for a national audience of coding professionals, surgical teams, and health policy analysts seeking a clear reference on the clinical scope and administrative framing of CPT code 42426.
Billing Code Overview
CPT code 42426 describes a surgical procedure in which the provider removes the entire parotid gland containing a tumor and performs a radical neck dissection on one side. This service is typically classified as a combined head and neck surgical oncology procedure.
Service type: Surgical - Head and Neck Oncology
Typical site of service: Hospital operating room or ambulatory surgical center
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting with a progressively enlarging, firm parotid mass with imaging and fine-needle aspiration suggesting a malignant neoplasm (for example, mucoepidermoid carcinoma or salivary duct carcinoma) with clinically or radiographically suspicious ipsilateral cervical lymphadenopathy. The patient undergoes preoperative evaluation including head and neck CT or MRI, chest imaging for staging, and routine perioperative labs. In the operating room under general anesthesia, the surgeon performs a total parotidectomy removing the entire ipsilateral parotid gland containing the tumor and performs a unilateral radical neck dissection (removal of lymphatic levels I–V with preservation or sacrifice of structures as indicated). Intraoperative considerations include facial nerve identification and monitoring, hemostasis, and possible reconstruction of soft-tissue defects. Postoperative care includes monitoring for facial nerve function, wound care, drainage management, pain control, and coordination with radiation oncology for adjuvant therapy if pathology confirms high‑risk features. Typical site of service is an inpatient hospital operating room or ambulatory surgical center with anticipated admission when extensive neck dissection or expected reconstruction is performed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No charge for professional component | Rare; used if professional component not billed (institution-specific) |