# cpt code 42961



## jocoffey (Jan 16, 2015)

Hi, is it appropriate to bill cpt code 42961 or is it considered part of the
global period after pt has had a T/A(42821).  The pt is hospitalized for
observation but no secondary surgical intervention was done.
Please help.  Thank You


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## Candice_Fenildo (Jan 18, 2015)

Because the hemorrhaging was extensive enough to require treatment in  the Hospital  you should report complex post-tonsillectomy  bleeding code 42961. 

Contributing factors  such as dehydration  or need for fluid replacement  in any patient who has bleeding may  warrant observation or hospitalization even after bleeding subside. 

On the other hand though. You have to consider the Payer.  Medicare does not pay for complications treated outside of the  operating room  you do not bill 42962 or 42961. (Medicare considers it  part of the global.)  Many private payers consider postoperative bleeding unrelated to the tonsillectomy and reimburse for 42960 and 42961. You would use -79 On the 42961


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