Otolaryngology Coding Alert

Question: An otolaryngologist performs a tonsillectomy and secondary adenoidectomy. May I separately code each surgery?

Minnesota Subscriber

Answer: No. Regardless of whether the patient previously had adenoids removed, you should instead use a tonsillectomy and adenoidectomy (T&A) code based on the patient's age:

• 42820 -- Tonsillectomy and adenoidectomy; younger than age 12
• 42821 -- Tonsillectomy and adenoidectomy; age 12 or over.

The T&A codes don't distinguish between primary or secondary adenoidectomy. So if the otolaryngologist performs both tonsillectomy and adenoidectomy for the first or second time, you should report only 42820 or 42821. Insurers consider separately reporting the procedures using a tonsillectomy and an adenoidectomy code -- such as 42825 (Tonsillectomy, primary or secondary; younger than age 12) and 42835 (Adenoidectomy, secondary; younger than age 12) -- unbundling. You only code a secondary adenoidectomy for removal of secondary regrowth when the secondary adenoidectomy is the only procedure performed, and the tonsils are not removed.