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Question: I have a question about the tonsillectomy/adenoidectomy hemostasis codes (42960-42972). Are they for use only if the patient is returning to the operating room (OR) or can you use them for hemostasis performed in the same operating session?

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Answer: Control of bleeding performed at the time of the tonsillectomy or adenoidectomy, usually performed by cautery, packing, or suturing, is considered inherent to the primary tonsillectomy procedures represented by these codes:

• 42820 (Tonsillectomy and adenoidectomy; younger than age 12)
• 42821 (… age 12 or over)
• 42825 (Tonsillectomy, primary or secondary; younger than age 12)
• 42826 (… age 12 or over)
• 42830 (Adenoidectomy, primary; younger than age 12)
• 42831 (… age 12 or over)
• 42835 (Adenoidectomy, secondary; younger than age 12)
• 42836 (… age 12 or over)

Conversely, codes 42960-42972 (see below) are intended to report control of post-tonsillectomy/adenoidectomy hemorrhage performed during a subsequent, separate operative session:

• 42960 (Control oropharyngeal hemorrhage, primary or secondary (e.g., post-tonsillectomy); simple)
• 42961 (... complicated, requiring hospitalization)
• 42962 (... with secondary surgical intervention)
• 42970 (Control of nasopharyngeal hemorrhage, primary or secondary (e.g., postadenoidectomy); simple, with posterior nasal packs, with or without anterior packs and/ or cautery)
• 42971 (... complicated, requiring hospitalization)
• 42972 (... with secondary surgical intervention)

According to the , “control of bleeding … is not separately reportable unless it requires a return to the operating room in the postoperative period.”

In other words, the hemostasis codes should be reported when:

• The patient experiences a postoperative hemorrhage and
• The provider performs a separate procedure to control the bleeding, typically involving:
  • A return to the OR or
  • A distinct operative encounter requiring anesthesia.

Jennifer McNamara, CPC, CRC, CDEO, CPMA, CVBA, CEMA, COSC, CGSC,
COPC, AAPC Approved Instructor, CEO, Healthcare Inspired LLC