How To Use CPT Code 42235

CPT 42235 describes the repair of defects in the hard palate using a flap from the vomer bone in the nose. 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 42235?

CPT 42235 is used to describe the surgical repair of defects in the hard palate. The procedure involves using a flap of tissue from the vomer bone in the nose to cover the cleft palate. This helps to close the channel between the oral and nasal cavities, allowing for proper functioning of the palate.

2. Official Description

The official description of CPT code 42235 is: ‘Repair of anterior palate, including vomer flap.’

3. Procedure

1. The provider begins by making an incision around the margins of the defect in the hard palate.
2. They then elevate the mucoperiosteal layer of the vomer bone and transpose it to the hard palate.
3. This leaves a portion of the vomer bone bare, which heals by secondary intention.
4. The flap from the vomer bone is positioned on the hard palate to close the channel between the oral and nasal cavities.
5. The provider checks for bleeding, removes any instruments, and closes the incision in the hard palate with sutures in layers.

4. Qualifying circumstances

CPT 42235 is performed on patients with defects in the hard palate that require surgical repair. The procedure is typically done to correct cleft palate or other abnormalities in the anterior palate. It is important to note that this code specifically refers to the repair of the anterior palate and the use of a vomer flap.

5. When to use CPT code 42235

CPT code 42235 should be used when a provider performs a surgical repair of defects in the hard palate using a vomer flap. It is important to ensure that the procedure specifically involves the anterior palate and the use of the vomer bone flap. If the procedure involves lengthening of the palate with flaps or cleft palate palatoplasty, different codes should be used.

6. Documentation requirements

To support a claim for CPT 42235, the provider must document the following information:

• Description of the defect in the hard palate
• Details of the surgical procedure performed, including the use of the vomer flap
• Date of the procedure
• Any complications or unexpected findings during the procedure
• Post-operative care instructions
• Signature of the provider

7. Billing guidelines

When billing for CPT 42235, it is important to ensure that the procedure performed matches the description of the code. The provider should use the appropriate code based on the specific procedure performed. It is also important to follow any specific guidelines or requirements set by the payer or insurance company.

8. Historical information

CPT 42235 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 a cleft palate undergoes a surgical repair of the anterior palate using a vomer flap.
2. A provider performs a repair of a defect in the hard palate using a vomer flap for a patient with an abnormality in the anterior palate.
3. A surgical team performs a procedure to close a channel between the oral and nasal cavities in a patient with a defect in the hard palate using a vomer flap.
4. A provider repairs a cleft palate in the anterior palate of a patient using a flap from the vomer bone in the nose.
5. A surgical procedure is performed to correct a defect in the hard palate using a vomer flap for a patient with an abnormality in the anterior palate.
6. A patient undergoes a surgical repair of the anterior palate using a flap from the vomer bone to close the channel between the oral and nasal cavities.
7. A provider performs a procedure to repair a defect in the hard palate using a vomer flap for a patient with an abnormality in the anterior palate.
8. A surgical team closes a channel between the oral and nasal cavities in a patient with a defect in the hard palate using a vomer flap.
9. A provider repairs a cleft palate in the anterior palate of a patient using a flap from the vomer bone in the nose.
10. A surgical procedure is performed to correct a defect in the hard palate using a vomer flap for a patient with an abnormality in the anterior palate.