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Otolaryngology Coding Alert

READER QUESTIONS:

Use Modifier When Only 1 Tonsil Comes Out

Published on Wed Apr 15, 2009

Question: My doctor and I are having a discussion on the correct way to code a tonsillectomy for a patient 12 or older if only one tonsil is removed. I think I should append a modifier for reduced service. He says that because a tonsillectomy is not a bilateral procedure, I can code it without a modifier whether one or both tonsils are removed. Kentucky Subscriber Answer: Youre correct. When your ENT performs a unilateral tonsillectomy on a patient aged 12 or older, code 42826-52 (Tonsillectomy, primary or secondary; age 12 or over). The codes for tonsillectomy and adenoidectomy (42820-42836) represent bilateral procedures. Do not append modifier 50 (Bilateral procedure) when your ENT performs them bilaterally. When your ENT performs the procedure unilaterally, then report the appropriate code and append modifier 52 (Reduced services).
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