Otolaryngology Coding Alert

Question: My provider did a tonsillectomy on a patient a couple weeks ago. The patient then came into the office during the global period of the tonsillectomy and had a cauterization of the throat done. I found code 42970 but am not sure if it is the correct code for the cauterization. Is there a different code that I should use for this or is this code appropriate for the cauterization of the throat? 

Virginia Subscriber 

Answer: If this is a Medicare patient, you are not able to bill for any services during the global period that do not involve a return to the surgery department or the endoscopy suite. That’s because the physician must use the operating room or endoscopy suite before you can report the return procedure and append modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) for a Medicare patient. 

But it sounds like the cautery (probably performed to stop a bleed) was performed in your office.  If so, it still is considered part of the global period and not billable for a Medicare patient.

Non-Medicare: If the patient does not have Medicare and their insurance does not indicate that they follow Medicare’s definition of when to bill for postoperative complications, you can follow the AMA CPT® rules for billing for complications in the postoperative period.  The AMA CPT® manual states in the beginning of the surgery section that postoperative complications are not part of the surgery and are separately coded and billed. There is no modifier for post-op complications that do not require a return to the operating room, so you have to use the 79 modifier (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period) and include the diagnosis for the reason for the cautery (such as 998.11, Hemorrhage complicating a procedure) which is unrelated to the reason the tonsillectomy was performed. If the cautery was as simple as you described, the procedure code would be as you found, 42970 (Control of nasopharyngeal hemorrhage, primary or secondary [e.g., postadenoidectomy]; simple, with posterior nasal packs, with or without anterior packs and/or cautery).