Otolaryngology Coding Alert

You Be the Coder:

Site of Service Affecting Tonsillectomy Code

Question: One of my doctors is considering doing in-office tonsillectomies.  I’m not sure if we can file with the regular code since that is done under general anesthesia. Is the unlisted code 42999 our best choice?

Wisconsin Subscriber

Answer: Nothing in CPT® refers to a specific type of anesthesia or method of removal for any of the tonsillectomy codes. The same codes should apply: 
  • 42820 – Tonsillectomy and adenoidectomy; younger than age 12
  • 42821 – … age 12 or over
  • 42825 – Tonsillectomy, primary or secondary; younger than age 12
  • 42826 – … age 12 or over. 
The only thing you should change on your claim is the place of service to POS 11 (Office). You also might want to pre-certify the procedure with the payer to be sure you won’t have problems with coverage or reimbursement.

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