Oral Surgery Coding & Reimbursement Alert
Append Appropriate Modifier For Postsurgical Complication Reporting
PDF
Question: A patient had resection of an oropharyngeal cancer about a month ago. The flap got displaced, and the patient was taken to the operating room for cauterization of the bleeding. Code 42962 says control of an oropharyngeal bleed but it also mentions the term “post-tonsillectomy.” Since the patient did not undergo a tonsillectomy, can I still use 42962 in this situation?
Ohio Subscriber
Answer: Yes. Although the patient did not have a tonsillectomy (such as 42826, Tonsillectomy, primary or secondary; age 12 or over) you may still use 42962 (Control oropharyngeal hemorrhage, primary or secondary [e.g., post-tonsillectomy]; with secondary surgical intervention). Codes 42960-42972 represent control of the hemorrhage and are delineated by hemorrhage location:
- 42960-42962 are for control of oropharyngeal hemorrhage
- 42970-42972 are for nasopharyngeal hemorrhage control.
The parenthetical references in 42960-42972 describe situations that may explain the hemorrhage’s cause. For instance:
The abbreviation e.g. in (e.g., post-tonsillectomy) and (e.g., postadenoidectomy) is for the Latin exempli gratia, for example.
Don’t forget: In this case, the hemorrhage control is a complication of the resection, such as 41153 (Glossectomy; composite procedure with resection floor of mouth, with suprahyoid neck dissection) and 42120 (Resection of palate or extensive resection of lesion).
As the complication occurred during the global period of the original procedure and your surgeon had to return the patient to the operating room, you should append modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) to 42962. Without the modifier, the insurer may bundle 42962 into the resection’s 90-day global period.
Make sure to link 42962-78 to the hemorrhage complication (T85.-, Complications of other internal prosthetic devices, implants and grafts), not to the reason for the original surgery. In your instance, since the flap got displaced, use T85.628A (Displacement of other specified internal prosthetic devices, implants and grafts, initial encounter).
Related Articles
Oral Surgery Coding & Reimbursement Alert
- CPT® 2016 Update:
Get a Sneak Peek into What to Expect For Oral Surgery Coding in CPT® 2016
Prolonged care codes cannot be used with new prolonged clinical staff service codes. Like [...] - ICD-10:
Kickoff With a Fresh Phase of ICD-10 Training After Implementation Date
Coders, clinicians must come together to solidify office’s ICD-10 coding. With all of the delays [...] - ICD-10:
Understand Grace Period To Ease into ICD-10 Implementation in Your Practice
Be ready to use ICD-10 or claims won’t fly. Amid the ocean of information CMS [...] - ICD-10:
Use These Expert TipsFor Successful ICD-10 Implementation
Communication between coders and providers is vital for success. With all the drama surrounding the [...] - You Be the Coder:
Know Your ICD-10 Options For Xerostomia
Question: Our surgeon recently made the diagnosis of xerostomia. What ICD-10 code should I use to [...] - Reader Question:
Understand When to Report 40810 and 40820 For Lesion Destruction
Question: Recently our oral surgeon performed removal of a lesion from the vestibule of the mouth. [...] - Reader Question:
Append Appropriate Modifier For Postsurgical Complication Reporting
Question: A patient had resection of an oropharyngeal cancer about a month ago. The flap got [...]