Otolaryngology Coding Alert

Secret: You can use 42820, 42821 as universal T&A codes.Warning: You must know a patient's age and prior surgery status before you code tonsillectomy and adenoidectomy claims. Otherwise, you could be choosing the wrong code or even unbundling procedures.Step 1: Check the Patient's AgeWhen coding for tonsillectomies and/or adenoidectomies, you should choose the appropriate code based on the patient's age.CPT contains two tonsillectomy codes, four adenoidectomy codes, and two combination codes - all of which separate at age 12. For a child who is under the age of 12, you will use:42820 - Tonsillectomy and adenoidectomy; under age 1242825 - Tonsillectomy, primary or secondary; under age 1242830 - Adenoidectomy, primary; under age 1242835 - Adenoidectomy, secondary; under age 12.When the patient is age 12 or older, you should assign:42821 - Tonsillectomy and adenoidectomy; age 12 or over42826 - Tonsillectomy, primary or secondary; age 12 or over 42831 - Adenoidectomy, primary; age [...]