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Help with tonsillectomy & biopsy

  1. Question Help with tonsillectomy & biopsy
    Medical Coding Books
    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

  2. Default
    There is guidance which indicates that tonsillectomy codes (42820-42836) are meant to represent bilateral procedures therefore mod -50 is 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,
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS

  3. Default 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


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