One of my ENT docs did a tonsillectomy with only a partial Adenoidectomy. I suggested 42820 or possibly 42820-52 since she only removed part of the adenoids, but she is arguing that taking only half the adenoid out is much more difficult than taking them all out so wants to bill 42820-22. She also is under the impression that the difficulty of the procedure should be evident from her op note (sounds very routine and no mention of difficulty that I can see) so she does not think any sort of statement of difficulty is necessary. I have been coding for 10 years but am new to ENT. Should it be the 42820 without any modifiers? This was my first thought after looking at the codes available. Or is it something else altogether that I am missing? Is there any reputable sources for guidance on this particular scenario that you could point me to? Especially if it is specific to ENT and/or this scenario?