Otolaryngology Coding Alert

Question: A surgeon performs a partial removal of the palatine or other tonsils with a CO₂ laser. May I use the tonsillectomy CPT codes?

Pennsylvania Subscriber

Answer: The American Academy of Otolaryngology -quot; Head and Neck Surgery (AAO-HSN) calls this tonsillectomy procedure carbon dioxide laser or laser tonsil ablation (LTA). In this technique, the otolaryngologist uses a CO₂ laser to remove tonsil tissue. LTA reduces tonsil volume and eliminates infection-collecting tonsil recesses.

"This procedure is recommended for chronic recurrent tonsillitis, chronic sore throats, severe halitosis, or airway obstruction caused by enlarged tonsils," according to the Academy's "Fact Sheet: Tonsillectomy Procedures." The procedure takes about 15 to 20 minutes in an office setting under local anesthesia. The patient leaves the office with minimal discomfort and returns to school or work the next day.

Because LTA removes tonsil tissue, rather than the tonsils, advice varies on whether to use the tonsillectomy code with the reduced service modifier (modifier 52) or to use an unlisted-procedure code. Some point to the section's subheading "destruction" inclusion to support applying the technique to 42825-42826 (Tonsillectomy, primary or secondary -).

In addition, the Coders- Desk Reference description for 42825-42826 states, "alternate surgical techniques for a tonsillectomy include electrocautery, laser surgery, and cryogenic surgery." Further, a tool alone does not change coding. Modifier 52 indicates partial, instead of complete, tonsil removal.

Payers may prefer an unlisted-procedure code. For instance, Highmark BlueShield (Pennsylvania) directs physicians to use "42999 (Unlisted procedure, pharynx, adenoids or tonsils) rather than 42826 (- age 12 or over) to report LAT (laser ablation of the tonsils)."

-- Answers to You Be the Coder and Reader Questions reviewed by Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CHCC, consulting director of education for The Coding Institute in Naples, Fla.; and Suzan Hvizdash, CPC, CPC-E/M, CPC-EDS, physician educator for University of Pittsburgh Medical Center's department of surgery in Pennsylvania.