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Question: How should you code a combined tonsillectomy and adenoidectomy provided during the same anesthetic session?

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Answer: Typically, when you are coding for anesthesia and there are two procedures performed during the same anesthetic session, report only the procedure that has the highest base unit value, according to the American Society of Anesthesiologists (ASA) Relative Value Guide^®.

For example, small benign skin lesions measuring 2.5 cm each are removed from the cheek and thigh during the same session. The related CPT^® codes are:

• 11443 (Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm)
• 11403 (Excision,  benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm)

Code 11443 (Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm) crosswalks to anesthesia code 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified) with a base unit value of 5; while code 11403 (Excision,  benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm) crosswalks to anesthesia code 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) with a base unit value of 3. Therefore code 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified) is reported because this carries the higher base unit value.

This same process would normally apply to a combined tonsillectomy and adenoidectomy; however, CPT^® provides us with a combined code. The correct code selection is based on the patient age. Our two CPT^® code options are as follows:

• 42820 (Tonsillectomy and adenoidectomy; younger than age 12)
• 42821 (Tonsillectomy and adenoidectomy; age 12 or over)

Both codes crosswalk to 00170 (Anesthesia for intraoral procedures, including biopsy; not otherwise specified); therefore, 00170 (Anesthesia for intraoral procedures, including biopsy; not otherwise specified) is the anesthesia code reported for a combined tonsillectomy and adenoidectomy.

Julie McDaniel, MHA, CPC, CANPC, Contributing Writer