Basics of CPT code for Tonsillectomy/Adenoidectomy

A tonsillectomy is a surgical procedure to remove the tonsils. Tonsils are two small glands located in the back of your throat. Tonsils house white blood cells to help you fight infection, but sometimes the tonsils themselves become infected. Specific codes are assigned for coding tonsillectomy. CPT code 42825 and 42826 are used to report tonsillectomy in medical coding. Also, sometimes the adenoids become swollen or enlarged because of infection, hence adenoidectomy is performed. An adenoidectomy is a surgery to remove the adenoids. CPT code 42830, 42831, 42835 & 42836 is used for reporting adenoidectomy.

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Description of CPT code 42825, 42826, 42830, 42831 , 42835 & 42836

42825 Tonsillectomy, primary or secondary; younger than age 12

42826 age 12 or over

42830 Adenoidectomy, primary; younger than age 12

42831 age 12 or over

42835 Adenoidectomy, secondary; younger than age 12

42836 age 12 or over

In tonsillectomy, the physician removes the tonsils. The tonsillectomy can be the first the patient has undergone, or a secondary procedure to remove tonsil regrowth since the primary procedure. The physician accesses the tonsils in an intraoral approach. First, the physician removes the tonsils by grasping the tonsil with a tonsil clamp and dissecting the capsule of the tonsil. The tonsil is removed. Bleeding vessels are clamped and tied. Bleeding may also be controlled using silver nitrate and gauze packing. Alternate surgical techniques for a tonsillectomy include electrocautery, laser surgery, and cryogenic surgery. CPT code  42825 is reported if the patient is under 12 years. For patients 12 years or older, use CPT code 42826.

In adenoidectomy, the physician removes the adenoids. Using an intraoral approach and a mirror or nasopharyngoscope for visualization, the physician uses an adenotome or a curette and basket punch to excise the adenoids. Alternate surgical techniques for an adenoidectomy include electrocautery, laser surgery, and cryogenic surgery. For adenoidectomy performed as a primary procedure (the initial removal of the adenoid), CPT code 42830 is reported for patients under 12 years;  use CPT code 42831 for patients 12 years and older. When performed as a secondary procedure (secondary procedure to remove adenoid tissue that has grown back since an initial adenoidectomy), use CPT code 42835 if the patient is under 12 years & assign CPT code 42836 for patients 12 years and older.

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When to use CPT code 42820 & 42821

Sometimes, the physician has to remove both tonsils and adenoids, hence the physician will perform both tonsillectomy and adenoidectomy together. So, for these scenario, we have to report CPT code 42820 & 42821 for combined tonsillectomy and adenoidectomy procedure.

42820 Tonsillectomy and adenoidectomy; younger than age 12

42821 age 12 or over

For this exam, the physician removes the tonsils and adenoids. The physician accesses the tonsils and adenoids in an intraoral approach. First, the physician removes the tonsils by grasping the tonsil with a tonsil clamp and dissecting the capsule of the tonsil. The tonsil is removed. Bleeding vessels are clamped and tied. Bleeding may also be controlled using silver nitrate and gauze packing. Using a mirror or nasopharyngoscope for visualization, the physician uses an adenotome or a curette and basket punch to excise the adenoids. Alternate surgical techniques for a tonsillectomy and adenoidectomy include electrocautery, laser surgery, and cryogenic surgery. CPT code 42820 is reported if the patient is under 12 years. For patients 12 years or older, use CPT code 42821.