Otolaryngology Coding Alert

Question: The otolaryngologist removes tonsils on both sides. Should we bill the tonsillectomy code with Modifier 50 to indicate bilateral procedure? Wisconsin Subscriber Answer: Modifier 50 (Bilateral procedure) does not apply to tonsillectomy and adenoidectomy codes (42820- 42836) since they already assume both-side surgery. The modifier applies to any procedure performed on both sides at the same session and to append it to tonsillectomy and adenoidectomy codes would be redundant and double billing. On the other hand, you should append modifier 52 (Reduced services) to the appropriate code when performing it unilaterally. For example, report 42825-52 (Tonsillectomy, primary or secondary; under age 12; Reduced services) for unilateral tonsillectomy for suspected cancer on a patient younger than 12. Tip: If you appeal the denial of a tonsillectomy on a child under the age of 12, point out the increased risk of complications and post-tonsillar bleeds found in children.