Otolaryngology Coding Alert

Question: Our physician performed the following procedures: 

1. Left total superficial parotidectomy with facial nerve dissection
2. Dermal fat graft from left abdomen
3. Intraoperative facial nerve monitoring.

We coded it as 42450-LT and 20926 but received a denial. What did we miss?  

Missouri Subscriber 

Answer: Code 42450 (Excision of sublingual gland) is not correct for parotidectomy. Instead, you should report 42420 (Excision of parotid tumor or parotid gland; total, with dissection and preservation of facial nerve) if the surgeon’s documentation shows that the facial nerve was preserved. Append modifier LT (Left side) to indicate the anatomic location.

Code 20926 (Tissue grafts, other [e.g., paratenon, fat, dermis]) is correct for the dermal fat graft from left abdomen. However, verify that the surgical notes include documentation of where your physician placed the graft to complete the surgery. A parotidectomy does not require a graft. If you don’t have complete documentation of that part of the procedure, that could be why the payer denied the claim.