I would report the combined tonsillectomy/adenoidectomy codes (42820/42821) even if the adenoidectomy is secondary since the code descriptor for these codes does not differentiate primary vs. secondary for the tonsillectomy or the adenoidectomy.
28.91 Removal of foreign body from tonsil and adenoid by incision convert 28.91 to ICD-10-PCS. 28.92 Excision of lesion of tonsil and adenoid convert 28.92 to ICD-10-PCS. 28.99 Other operations on tonsils and adenoids convert 28.99 to ICD-10-PCS.
Unfortunately, CMS considers the adenoids, faucial tonsils, and lingual tonsils to reside in an anatomically related area. CPT code 42870 includes the “separate procedure” designation and CMS payment policy does not allow payment when the procedure described by that code is performed with another procedure in an anatomically related area.
I think anesthesia cross for Adenotonsillectomy is 00170 (Intra oral procedures). Cpt code 42825-00170... I thought of it. But I am not satisfied because it is for intra oral procedures , not other wise specified.
ICD-10-PCS Code 0CBPXZZ - Excision of Tonsils, External Approach - Codify by AAPC.
Other chronic diseases of tonsils and adenoids J35. 8 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM J35. 8 became effective on October 1, 2021.
CPT® Code 42820 in section: Tonsillectomy and adenoidectomy.
CPT42821Tonsillectomy and adenoidectomy; age 12 or over42825Tonsillectomy, primary or secondary, younger than age 1242826Tonsillectomy, primary or secondary, age 12 or overICD-10 Procedure9 more rows
89.
Adenoidectomy: A surgical procedure to remove the adenoids....CPT42831Adenoidectomy, primary; age 12 or over42835Adenoidectomy, secondary; younger than age 1242836Adenoidectomy, secondary; age 12 or overICD-10 Procedure7 more rows
CPT® 42140, Under Excision and Destruction Procedures on the Palate and Uvula. The Current Procedural Terminology (CPT®) code 42140 as maintained by American Medical Association, is a medical procedural code under the range - Excision and Destruction Procedures on the Palate and Uvula.
A: You should code this service with CPT code 30140 – Submucous resection inferior turbinate, partial or complete, any method with modifier 50- Bilateral procedures.
Tonsillectomy and adenoidectomyCPT® Code 42821 in section: Tonsillectomy and adenoidectomy.
“Secondary” refers to a second surgery to remove portions of the tonsil or adenoid missed during the primary procedure or which grew back subsequent to the primary procedure.
Most payers consider tonsillectomy and adenoidectomy codes to be bilateral. For Tonsillectomy, primary or secondary, see 42825 and 42826. For adenoidectomy, primary, see 42830 and 42831; secondary, see 42835 and 42836.
CPT for ENT: Lingual Tonsillectomy (CPT 42870) and Adenoidectomy - American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)
ICD-10 code J03. 90 for Acute tonsillitis, unspecified is a medical classification as listed by WHO under the range - Diseases of the respiratory system .
Most payers consider tonsillectomy and adenoidectomy codes to be bilateral. For Tonsillectomy, primary or secondary, see 42825 and 42826. For adenoidectomy, primary, see 42830 and 42831; secondary, see 42835 and 42836.
Modifier -52 identifies that the service or procedure has been partially reduced or eliminated at the physician's discretion. The basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
A tonsillectomy was once a common procedure to treat infection and inflammation of the tonsils (tonsillitis). Today, a tonsillectomy is usually performed for sleep-disordered breathing but may still be a treatment when tonsillitis occurs frequently or doesn't respond to other treatments.