Otolaryngology Coding Alert

Question: When we have a postoperative tonsillectomy bleed, the patient is returned to the OR, and usually a cauterization is done. We have been using 42960. Should we be using 42962 instead?

Nebraska Subscriber

Answer: Use 42962 (control oropharyngeal hemorrhage, primary or secondary [e.g., post-tonsillectomy]; with secondary surgical intervention) whenever the patient is brought back to the OR. The code's descriptor says that when a "secondary surgical intervention," i.e., a return to the OR, occurs, 42962 is used.
 
The other two codes in the series, 42960 (control oropharyngeal hemorrhage, primary or secondary [e.g., post-tonsillectomy]; simple) and 42961 (... complicated, requiring hospitalization), are for simpler procedures. If the physician treats the patient in the office, use 42960. If there is concern about blood loss, the doctor may admit the patient to the hospital, or send him to the ER. In both cases, use 42961.
 
Code 42962 should be reserved for when the otolaryngologist's attempts to control the post-tonsillar bleed have failed and the patient is returned to the OR for additional surgery. If, as is likely, the return to the operating room occurs during the 90-day global period of the tonsillectomy (42825, tonsillectomy, primary or secondary; under age 12; and 42826, ... age 12 or over), append 42962 with modifier -78 (return to the operating room for a related procedure during the postoperative period) to let the carrier know that the control of bleeding is not included in the procedure's global package.