Otolaryngology Coding Alert

Stop Oozing Reimbursement With Post-Tonsillar Bleeding Fundamentals


- Published on Sun, Sep 01, 2002

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Because three different codes describe post-tonsillar bleeding, correct coding can be tricky, but the key to optimum reimbursement is determining the place of service.

Use Three Codes for Postop Bleeding

Studies show bleeding occurs in 1or 2 percent of post-tonsillectomy patients" " says Hayes H. Wanamaker MD Central New York Ear Nose & Throat Consultants. "Primary bleeding occurs within 24 hours (usually within the first two to four hours); delayed bleeding typically occurs in the first five to seven days."

Regardless of when the hemorrhaging occurs CPT assigns three codes for control of post-tonsillar bleeding:

  • 42960 Control oropharyngeal hemorrhage primary or secondary [e.g. post-tonsillectomy]; simple
  • 42961 complicated requiring hospitalization
  • 42962 with secondary surgical intervention.

    Location Location Location

    Depending on the severity of bleeding the otolaryngologist treats the patient in the:

    1. office
    2. hospital
    3. or the operating room (OR).

    By knowing the levels of bleeding and typical treatments in each location you can correctly choose the appropriate post-tonsillar hemorrhage code. All postoperative complications are included in the global period of the original procedure. Therefore modifiers will apply to these codes as discussed later.

    Office Treatment Qualifies As Simple

    "Bleeding may be brief and self-limited or stop after ice-water gargles " Wanamaker says. "These symptoms require only office follow-up which is generally included in the global as postoperative care. More severe bleeding may require an office visit for packing or cautery coded as 42960 site of visit in-office [11]."

    For example suppose a healthy post-tonsillectomy adult has severe bleeding two days after surgery and presents to the otolaryngologist's office. The physician discovers the hemorrhaging is coming from the right fossae. He controls the bleeding by simple cautery.

    "42960 is the appropriate code to use if the patient is treated in the office with simple cautery " says Beth Thomsen CPC Associated Physicians of MCO Inc. Toledo Ohio.

    Hospitalization Warrants Complex Care

    "Active persistent bleeding may require control in the emergency room where sedation topical or local anesthetic pain control fluid replacement and hematologic studies may be performed " Wanamaker explains. "The patient may either have observation status or be admitted for observation/treatment."

    "42961 is indicated if the patient requires additional treatment or observation in an outpatient inpatient-bedside hospital setting or emergency room " Thomsen says.

    For instance a 27-year-old male has excessive persistent bleeding. The physician is unable to treat the patient in the office and sends him to the emergency room. In the ER the otolaryngologist applies tannic acid to the affected site and the bleeding subsides. Assign 42961.

    Because the hemorrhaging was extensive enough to require treatment in the emergency room you should report complex post-tonsillectomy bleeding code 42961.

    Contributing factors such as dehydration or need [...]

  • Otolaryngology Coding Alert
    Issue - Sep, 2002
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