Question Clarification of post tonsillectomy bleed

Manders21

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I just want to make sure I'm using the correct cpt code because I have read a few different things so I am a little confused which code to use. From my understanding code 42960 is for a post tonsillectomy bleed that can be fixed in the office. Code 42961 is when they can't fix it in the office so they send the patient to the hospital. And 42962 is when they take the patient to the OR. But I also read that if cauterization is done the code is 42960 and if suture ligation of bleeding vessels is done that is code 42962. So that is where I am confused and want to make sure I'm coding this right. Below is the op report.

Patient was taken to surgery induced with general anesthesia and intubated. Shoulder roll was placed to provide neck extension. Patient was then properly prepped and draped. McIvor mouth gag was inserted into the mouth and patient was suspended from the Mayo stand. Attention was turned to the left fossa. A large clot was suctioned off revealing a bleeding vessel in the midpole region. This was cauterized using suction cautery. Once hemostasis was achieved the mouth gag was released and the patient was valsalva'd to 35 mmHg twice. The mouth gag was then resuspended and any areas of oozing were cauterized. The stomach was then suctioned and Floseal was placed in bilateral tonsillar foassas. Case was completed. All instrumentation was removed and patient was sent to recovery in satisfactory condition.

Also, the physician that did the original tonsillectomy is from a different office. But I would still use modifier 78 right?
 

wisibyusha

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You said the operative report which indicates the patient is taken to OR for surgical intervention so the appropriate code would be 42962 by appending modifier 78.
 

fwnewbie

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Got my book out and I don't understand why you would question using 42962. 42961 would only be used if the patient was admitted due to the complications, and a return to OR in is the only option for this case. The semicolon before the word "simple" in 42960 is important to notice so review what the punctuation means in these codes or it will throw you.
I couldn't figure out what you were talking about until I looked at my book. :)
 

Manders21

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Got my book out and I don't understand why you would question using 42962. 42961 would only be used if the patient was admitted due to the complications, and a return to OR in is the only option for this case. The semicolon before the word "simple" in 42960 is important to notice so review what the punctuation means in these codes or it will throw you.
I couldn't figure out what you were talking about until I looked at my book. :)
thank you!
 

b.cobuzzi

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I have a post op global/modifier issue I would like to add here.
Medicare part b will not pay for complications treated in the ED, bedside or in the office. You cannot bill medicare part b patients for control of post op tonsil bleed controlled in the office or the ED. You can only bill medicare part b if it is necessary to go to the OR for secondary intervention and then you will bill 42962-78 as was answered.

But AMA CPT says in the beginning of the surgical section of your cpt book that AMA CPT does not consider treatment of excerbations or complications as part of the global package. As a result, you need to know whether a non-Medicare Part B payer follows Medicare Part B global rules or AMA CPT rules. If they follow AMA CPT rules, you can bill for a post op tonsil bleed treated in the office or ED. You will need to use the ICD-10 - J95.830 Postprocedural hemorrhage of a respiratory system organ or structure following a respiratory system procedure(not the tonsil diagnosis) and bill the control of the bleed as 42960-79.

I agree, that your op note describes 42962-78 for your patient.
 
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