Wiki 2ndary adenoidectomy

[Jamie Dezenzo]

Hello ENT coders!

6 yr old pt had tonsils removed and was scheduled for a tonsillectomy at the end of the op note reads:

Patient had adenoid bed inspected and had a previous adenoidectomy. There was a very small amount of adenoid tissue residual by the posterior choana superiorly which was vaporized at 40 watts; however, the remining portion was left alone.

Did not state blocking and did not remove all? How would you bill in this case?

Thanks
Jamie

 

[bethh05]

How did you end up coding for this?

 

[Jamie Dezenzo]

still not sure....any thoughts?

 

[Jamie Dezenzo]

decided on 42820/ 42821 since doesn't clarify PRIMARY/or SECONDARY

www.supercoder.com/Otolaryngology Coding Alert- Surefire Steps You Need to Avoid Tonsil/Adenoid Removal Miscodes

 

[jessj5548]

I would code 42820 as the child is younger than 12. I do not see anything that says this code does not apply if they do not remove all of the adenoid tissue. And you are correct primary vs secondary does not matter when combined with tonsillectomy.