Otolaryngology Coding Alert

Question: What is the appropriate code for post-tonsillectomy hemorrhage?

Pennsylvania Subscriber

Answer: Depending on the postprocedural complication, you might have the option to code toward a greater degree of specificity than other complications. In the case of a postprocedural hemorrhage, there are a set of codes youcan apply depending on the scenario and anatomical location.

The list of postsurgical hemorrhage codes is broad, extending from subcutaneous tissue to the musculoskeletal system to the respiratory and digestive tracts. In this example, you will be deciding between the latter two.

However, in order to answer this question correctly, an associated CPT® code is necessary to check the crosswalk between the procedure code and diagnosis code. You will code most post-tonsillectomy hemorrhages with one of three codes:

• 42960 (Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); simple)
• 42961 (Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); complicated, requiring hospitalization)
• 42962 (Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); with secondary surgical intervention) 

Assuming that these procedures describe the physician’s services, the correct ICD-10 code will be found in the “J” section of the ICD-10 index. The correct code for post-tonsillectomy hemorrhage is J95.830 (Postprocedural hemorrhage of a respiratory system organ or structure following a respiratory system procedure). You will see that 42960, 42961, and 42962 all cross-code to J95.830 in Codify’s crosswalk coding tool.