Otolaryngology Coding Alert

Question: Doctor performed a T&A and placed Vitagel tissue seal over the adenoid and tonsil bed. Should I separately report the seal?

Answer: No, you should include the seal in the tonsillectomy and adenoidectomy (T&A) 42820-42821, Tonsillectomy and adenoidectomy ...). The seal is integral to the procedure, just as any closing would be. After removing a patient's tonsils and adenoids, the otolaryngologist may spray Vitagel onto the wounds to promote blood clotting.

Example: An otolaryngologist removes a 4-year-old's tonsils and adenoids due to chronic tonsillitis and adenoiditis. The surgeon uses an electrocautery knife to remove the tonsils and adenoids through the mouth. The knife uses electricity to create a small burn at the raw edge of the tissue and seal the blood vessels closed to prevent bleeding. He then places Vitagel over the adenoid and tonsil bed to help the body in clotting.

You would code this example as 42820 (Tonsillectomy and adenoidectomy; younger than age 12) with 474.02 (Chronic tonsillitis and adenoiditis). Consider the seal a component of the closure.