Otolaryngology Coding Alert

Question: An 11-year-old patient undergoes primary tonsillectomy due to acute recurrent tonsillitis caused by Haemophilus influenzae. The ENT treats the child in the office four days later for postoperative nasopharyngeal bleeding. What diagnosis and procedure codes are reported?

Alabama Subscriber

Answer: Because your ENT indicates pathology shows recurrent tonsillitis due to Haemophilus influenzae, you can rule out the streptococcal tonsillitis codes: J03.00 (Acute streptococcal tonsillitis …) and J03.01 (Acute recurrent streptococcal tonsillitis), and the unspecified tonsillitis codes: J03.90 (Acute tonsillitis, unspecified) and J03.91 (Acute recurrent tonsillitis, unspecified). So for the recurrent acute tonsillitis, report J03.81 (Acute recurrent tonsillitis due to other specified organisms) and B96.3 (Hemophilus influenzae [H. influenzae] as the cause of diseases classified elsewhere), as ICD-10 directs you to “use additional code (B95-B97) to identify infectious agent.”

For the tonsillectomy, use 42825 (Tonsillectomy, primary or secondary; younger than age 12), and on a separate claim four days later, bill 42970 (Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); simple …) for the post-op bleeding control.

Make sure to append modifier 79 (Unrelated procedure or service by the same … during the postoperative period) to 42970 to indicate this was an unrelated procedure during the global period of the tonsillectomy. It’s unrelated because the hemostasis is being done to treat postoperative bleeding, coded to J95.830 (Postprocedural hemorrhage of a respiratory system organ or structure following a respiratory system procedure), not for the reason the ENT performed the tonsillectomy originally. The payer should recognize and reimburse both codes.