General Surgery Coding Alert

Question: For a case involving a peritonsillar abscess (PTA), the surgeon performed an incision and drainage procedure to treat the condition. What are the correct diagnosis and procedure codes for the case?

Arkansas Subscriber

Answer: Most likely the best procedure code for this case is 42700 (Incision and drainage abscess; peritonsillar). But if the surgeon provides more specific information about the surgical approach, you might need to turn to one of the following codes:

• 42720 (Incision and drainage abscess; retropharyngeal or parapharyngeal, intraoral approach)
• 42725 (… retropharyngeal or parapharyngeal, external approach).

Coding the peritonsillar abscess diagnosis requires that you adhere to the instructions listed underneath the primary diagnosis.

To assign an ICD-10-CM code for this case, you should use the index to determine that a peritonsillar abscess is J36 (Peritonsillar abscess). Make sure to review both the “Use additional” and “Excludes1” notes underneath J36.

According to the ICD-10-CM guidelines, you should “Use additional code (B95-B97) to identify infectious agent.” Based on the documentation for the case, you will use a code from B95-B97 to report the infectious agent, such as B95.0 (Streptococcus, group A, as the cause of diseases classified elsewhere).

Excludes: Even if you have a “tonsillitis” ordering diagnosis for this case, you should not separately report the condition. The “Excludes1” note underneath J36 indicates that you should not list J35.0- (Chronic tonsillitis and adenoiditis) or J03.9- (Acute tonsillitis, unspecified) in addition to the primary diagnosis of J36.