How To Use CPT Code 42226

CPT 42226 describes a procedure that involves the lengthening of the soft palate by transferring tissue flaps, including pharyngeal flaps and flaps from the hard palate, to the soft palate. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 42226?

CPT 42226 is a code used to describe a procedure in which the soft palate is lengthened by transferring tissue flaps from the pharyngeal wall and the hard palate to the soft palate. This procedure is performed to reduce the amount of air through the nose and improve airflow. It is typically done to address issues related to the obstruction of airflow and may be necessary for patients with certain conditions or anatomical abnormalities.

2. Official Description

The official description of CPT code 42226 is: ‘Lengthening of palate, and pharyngeal flap.’

3. Procedure

1. The provider begins by making a midline incision in the soft palate.
2. Tissue flaps are raised from the posterior pharyngeal wall and stitched to the soft palate.
3. Lateral holes are left open on each side of the flap to prevent the obstruction of airflow.
4. Flaps may also be advanced from the hard palate.
5. The provider checks for bleeding, removes any instruments, and closes the incision in the mucosa with sutures in layers.

4. Qualifying circumstances

CPT 42226 is typically performed on patients who require the lengthening of the soft palate to address issues related to the obstruction of airflow. This procedure may be necessary for patients with conditions such as sleep apnea or anatomical abnormalities that affect the function of the soft palate. It is important to note that the specific circumstances for performing this procedure may vary depending on the patient’s individual needs and the professional judgment of the provider.

5. When to use CPT code 42226

CPT code 42226 should be used when the provider performs a procedure to lengthen the soft palate by transferring tissue flaps from the pharyngeal wall and the hard palate. This code is appropriate when the procedure is performed to address issues related to the obstruction of airflow and improve the patient’s ability to breathe properly. It is important to review the documentation and medical necessity of the procedure to ensure accurate coding and billing.

6. Documentation requirements

To support a claim for CPT 42226, the provider must document the following information:

• Indication for the procedure and the medical necessity
• Details of the procedure performed, including the specific tissue flaps used and any modifications made
• Date of the procedure
• Any complications or unexpected findings
• Post-procedure instructions or recommendations
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 42226, it is important to ensure that the documentation supports the medical necessity of the procedure. The provider should use the appropriate CPT code based on the specific procedure performed. It is also important to review any applicable payer guidelines and requirements for accurate billing and reimbursement. Additionally, it is important to note that there may be specific coding considerations or modifiers that need to be applied based on the circumstances of the procedure and the patient’s insurance coverage.

8. Historical information

CPT 42226 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with sleep apnea undergoes a procedure in which tissue flaps are transferred from the pharyngeal wall and the hard palate to lengthen the soft palate and improve airflow.
2. A provider performs a procedure to address issues related to the obstruction of airflow in a patient with anatomical abnormalities affecting the soft palate.
3. A patient with breathing difficulties due to a previous surgery undergoes a procedure to lengthen the soft palate using tissue flaps from the pharyngeal wall.
4. A provider performs a procedure to improve the patient’s ability to breathe properly by transferring tissue flaps from the hard palate to the soft palate.
5. A patient with a history of nasal congestion and difficulty breathing undergoes a procedure in which tissue flaps are raised from the posterior pharyngeal wall and stitched to the soft palate to improve airflow.
6. A provider performs a procedure to address issues related to the obstruction of airflow in a patient with sleep-disordered breathing by advancing flaps from the hard palate to the soft palate.
7. A patient with a history of snoring and disrupted sleep undergoes a procedure to lengthen the soft palate using tissue flaps from the pharyngeal wall and the hard palate.
8. A provider performs a procedure to improve the patient’s ability to breathe properly by transferring tissue flaps from the pharyngeal wall to the soft palate.
9. A patient with a history of sleep apnea and difficulty breathing undergoes a procedure in which tissue flaps are raised from the posterior pharyngeal wall and stitched to the soft palate to reduce the obstruction of airflow.
10. A provider performs a procedure to address issues related to the obstruction of airflow in a patient with anatomical abnormalities affecting the soft palate and the pharyngeal wall.