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Otolaryngology Coding Alert

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Is 42962 Tied to 42826?

Question: A patient had resection of an oropharyngeal cancer about a month ago.

The pectoralis flap pulled away, and the patient was taken to the operating room for cauterization of the bleeding. Code 42962 says post-tonsillectomy and control of an oropharyngeal bleed. Can I use 42962 in this situation?

Ohio Subscriber

Answer: Yes. Although the patient did not have a tonsillectomy (such as 42826, Tonsillectomy, primary or secondary; age 12 or over) you may still use 42962 (Control oropharyngeal hemorrhage, primary or secondary [e.g., post-tonsillectomy]; with secondary surgical intervention). Codes 42960-42972 represent control of the hemorrhage and are delineated by hemorrhage location:

- 42960-42962 are for control of oropharyngeal hemorrhage
- 42970-42972 are for nasopharyngeal hemorrhage control. The parenthetical references in 42960-42972 describe situations that may explain the hemorrhage's cause. For instance:

- oropharyngeal hemorrhage control may be needed  after a tonsillectomy
- nasopharyngeal hemorrhage control may be needed after an adenoidectomy. The abbreviation e.g. in -(e.g., post-tonsillectomy)- and -(e.g., postadenoidectomy)- is for the Latin exempli gratia, -for example.-

Don't forget: In this case, the hemorrhage control is a -complication- of the resection, such as 41153 (Glossectomy; composite procedure with resection floor of mouth, with suprahyoid neck dissection) and 42120 (Resection of palate or extensive resection of lesion).  

Because the complication occurred during the global period of the original procedure, and because the otolaryngologist had to return the patient to the operating room, you should append modifier 78 (Return to the operating room for a related procedure during the postoperative period) to 42962. Without the modifier, the insurer may bundle 42962 into the resection's 90-day global period.

Make sure to link 42962-78 to the hemorrhage complication (996.xx, Complications peculiar to certain specified procedures), not to the reason for the original surgery. For instance, if the cause of flap failure was mechanical, meaning due to nonintegration of the flap, use 996.59 (Mechanical complication of other specified prosthetic device, implant, and graft; due to other implant and internal device, not elsewhere classified).

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