CPT Assistant, June 2021, Volume 31, Issue 6, page 14
Question:
What is the correct coding for an intracapsular tonsillectomy with adenoidectomy? Is it appropriate to indicate reduced services by appending a modifier to the code because a thin layer of tonsil was left in place?
Answer:
It would be appropriate to report the age-appropriate tonsillectomy with adenoidectomy code 42820, Tonsillectomy and adenoidectomy; younger than age 12, or 42821, Tonsillectomy and adenoidectomy; age 12 or over, without appending modifier 52, Reduced Services. Similarly, if only an intracapsular tonsillectomy was performed, it would be reported with the unmodified and age-appropriate code 42825, Tonsillectomy, primary or secondary; younger than age 12, or 42826, Tonsillectomy, primary or secondary; age 12 or over. This is because the work involved and the surgical outcome achieved are essentially the same as a classic tonsillectomy. To clarify, "intracapsular" refers only to the tonsillectomy; there is no capsule associated with the adenoids. There is no coding difference for tonsillectomies performed with different modalities (eg, scalpel, electrocautery, laser, radiofrequency ablation) because the work and outcomes are similar.
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