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Otolaryngology Coding Alert

Reader Questions:

Code for I&D at Different Tonsil Site

Published on Fri Mar 12, 2010

Question: The ENT saw a 24-year-old patient in the ER for a peritonsillar abscess. Then, she admitted the patient for an I&D of abscess and also a tonsillectomy. Can we bill for both procedures or just the removal? Answer: The two procedures you describe (42700, Incision and drainage abscess; peritonsillar, and 42826, Tonsillectomy, primary or secondary; age 12 or over) are not bundled together per the National Correct Coding Initiative edits. However: The payer should not have to reimburse for an incision and drainage (I&D) for a part that the otolaryngologist removed for the tonsillectomy. To report both the incision and drainage (I&D) and the tonsillectomy, the ENT must have performed the I&D in a different site from the parts of the tonsils that she removed. Be sure that the different sites are documented in the op report. The only other reason to charge for both when performed in the [...]
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