Wiki Help with tonsillectomy & biopsy

[Jody Mortensen]

Can anyone help me with CPT code selection for the following: The surgeon did a left tonsillectomy & removed 5mm of the right tonsil to biopsy. Would I use CPT code 42826 with a 22 modifier since only a small portion of the right was removed, or 42826-Lt with a biopsy code for the right? Would the biopsy code be 42800-Rt. Your help is greatley appreciated.

Thank you
Jody Hecht

 

[ciphermed]

There is guidance which indicates that tonsillectomy codes (42820-42836) are meant to represent bilateral procedures therefore mod -50 is inappropriate...in addition if performed unilaterally should be reported with mod -52 appended...

Does not appear to be correct to append mod-lt to 42826.

Whether or not the Bx on the right should be coded??? not sure

42826 with -52 already indicates that the procedure was reduced.

...hope this helps,

 

[lissalea]

Tonsil Biopsy

Hi Jody~ I know this is about 4 years too late, but I was just searching for this myself. I found on another website that the correct ICD-9 px code is 28.11 and when I crosswalked it, I came up with 42999. I am hoping it doesn't get denied for unlisted

Liss