Otolaryngology Coding Alert

Question: The otolaryngologist performs a tonsillectomy on a 3-year-old boy. Suction cautery of the adenoids is also performed because the lateral bands of the adenoids (especially superiorly) were obstructing the outflow of the nasal choana by at least 30 to 40 percent. The child has had a previous adenoidectomy. Does the current session qualify as a tonsillectomy and adenoidectomy (T&A)?

Nebraska Subscriber

 Answer: Cautery of the adenoids is considered adenoidectomy: CPT does not include a separate code for destroying the adenoids using this or any other method. The correct code would be 42820 (Tonsillectomy and adenoidectomy; under age 12).
 
Although there are separate codes for the tonsillectomy (42825, Tonsillectomy, primary or secondary; under age 12) and the adenoidectomy (42835, Adenoidectomy, secondary; under age 12), it is more accurate to use a combined code when both procedures are performed during the same session. Carriers may consider the use of separate codes for the two procedures as unbundling even though the Correct Coding Initiative does not edit 42825 and 42835.
 
Note: The adenoidectomy is considered secondary because a previous adenoidectomy was already performed.