tci Outpatient Facility Coding Alert - 2013 Issue 3

You Be the Coder: Coding for Tissue Welding Tonsillectomy

Question: What CPT® code is appropriate for tissue welding tonsillectomy? Can I use code 42826 with modifier 22 or should I use unlisted code? And, can we use modifier 22 for Facility/ASC billing? New Hampshire Subscriber Answer:  A tonsillectomy can be performed by cryotherapy, laser, or electrocautery methods. Choose code 42825 (Tonsillectomy, primary or secondary; younger than age 12) or 42826 (… age 12 or over), depending on the patient’s age. The method the surgeon chooses doesn’t affect the code.  Modifier 22 (Unusual procedural service) is not allowed for facility or ASC billing. Coders can sometimes...

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