Otolaryngology Coding Alert

Question: Our otolaryngologist performed a lateral pharyngoplasty, then he excised enough tissue from the soft palate and uvula to allow flattening of the posterior pharyngeal reflux wall. He excised the redundant uvula and performed uvuloplasty. A portion of the uvularis muscle was partially excised and a series of vicryl was then used to reapproximate the mucosa to create the neouvula. The surgeon insists that 42145 is not correct. How should I code this?

Delaware Subscriber

Answer: It is difficult to determine the exact code without the entire operative note as well as knowing the reason the surgery was performed, but it seems like 42950 (Pharyngoplasty [plastic or reconstructive operation on pharynx]) might be a better code than 42145 (Palatopharyngoplasty [e.g., uvulopalatopharyngoplasty, uvulopharyngoplasty]).

Procedure: Surgeons normally perform uvulopharyngoplasty to treat malignant neoplasm of the oral cavity and pharynx. During the procedure, the physician advances soft tissue of the posterior pharyngeal wall by suturing palatopharyngeal muscles. He then folds back a flap of pharyngeal mucosa on itself to achieve further reconstruction.