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Otolaryngology Coding Alert

You Be the Coder:

Pairing Codes When Reporting T&A

Question: One of our insurers has very strict guidelines for a T&A. Often times, the patient meets medical necessity and medical criteria for an adenoidectomy but doesn’t medical necessity for the tonsillectomy. Are we allowed to only report the adenoidectomy code (42830) to the insurance carrier despite the patient having a tonsillectomy and adenoidectomy performed? Or, should we unbundle the codes [...]

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