Otolaryngology Coding Alert

Question: My 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 one of the tonsillectomy and adenoidectomy codes:

- 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 will think you-re trying to get around the bundling fraudulently if you report the procedures separately -- such as 42825 (Tonsillectomy, primary or secondary; younger than age 12) and 42835 (Adenoidectomy, secondary; younger than age 12).You only report the secondary adenoidectomy if that is all the ENT does.