tci Outpatient Facility Coding Alert - 2016 Issue 1

ENT Spotlight: Consider These Factors to Find Success with Tonsillectomy Claims

Pay attention to whether post-op bleeding is payable. Tonsillectomy and adenoidectomy cases might be common in your facility, but that doesn’t mean the billing is always straightforward. Multiple factors come into play when you’re considering how to code your surgeon’s work, so keep our experts’ advice in mind the next time you tackle a claim. Start by Verifying the Patient’s Age The first distinction between tonsillectomy and adenoidectomy codes is based on two age groups: under 12 years, or age 12 and over. Your choices are as follows: 42820 —Tonsillectomy and adenoidectomy; younger than...

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