Otolaryngology Coding Alert

Current diagnosis 474.12 will make an easy shift. 

When your otolaryngologist diagnoses hypertrophy of adenoids, you have a single ICD-9 code to report: 474.12 (Hypertrophy of adenoids alone). Your code choice will be just as simple when ICD-10 becomes effective Oct. 1. 

ICD-10 option: The new diagnosis under ICD-10 will be J35.2 (Hypertrophy of adenoids). Another term that a physician might use to describe this condition is “enlargement of adenoids.” 

Documentation: Insurers may require you to submit documentation showing repeated strep or other infections before they will grant prior authorization for adenoidectomy because surgery should be the last course of treatment for an individual who has repeat infections. In this case, it would be best for you to obtain preauthorization from the payer to ensure coverage.

Coder tips: Your physician may perform a nasalpharyngoscopy to examine a patient’s upper airways for hypertrophy of adenoids, especially if the patient’s condition is not improving or if the otolaryngologist cannot get an accurate diagnosis from a nasal speculum and mirror exam. You would report this with 92511 (Nasopharyngoscopy with endoscope [separate procedure]).

To treat the condition, a physician would most likely perform adenoidectomy, which you would report with 42830 (Adenoidectomy, primary; younger than age 12) or 42831 (…age 12 or over) for primary procedures, and 42835 (Adenoidectomy, secondary; younger than age 12) or 42836 (…age 12 or over) for secondary procedures. 

About the condition: Adenoids are tonsil-like glands located at the back of the nose. Patients with hypertrophy of adenoids have enlarged adenoid tissues that can potentially block nasal passages completely, or can cause sleep disturbances.