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Tip: Know your T&A procedures

Ambulatory Surgery Reimbursement Update, April 1, 2008

Tonsillectomy and adenoidectomy (T&A) procedures are considered bilateral and do not require modifier -50 (bilateral) for billing. The 2008 CPT Manual indicates that if a physician only operates on or removes one side, billers and coders should append modifier -52 (for reduced services) to the CPT code.

Code T&A procedures based on what the physician removes and the patient's age.

Physicians are increasingly performing adenoidectomy procedures separately from tonsillectomy procedures. Adenoidectomies help patients who suffer from recurrent middle-ear diseases or infections. Adenoidectomy codes are distinguished by whether they are primary (the initial removal surgery of the adenoid[s]) or secondary (for the removal of remaining portions of the adenoid[s] missed during the primary procedure), and by the patient's age. Diagnosis coding for the adenoidectomy procedure is important. The best code to use is 474.01 for chronic adenoiditis, if it is applicable. If coders report hypertrophy of the adenoids, the claim may be denied for medical necessity reasons.

This tip is brought to you by Ellis Medical Consulting, Inc.

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