How To Use CPT Code 42700

CPT 42700 describes the procedure of incision and drainage of a peritonsillar abscess. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 42700?

CPT 42700 is used to describe the incision and drainage of a peritonsillar abscess. This procedure involves making an incision into the abscess next to one of the tonsils to allow for drainage. It is typically performed when a patient has a peritonsillar abscess, which is an area of infection next to one of the tonsils that may occur due to tonsillitis.

2. Official Description

The official description of CPT code 42700 is the “Incision and drainage abscess; peritonsillar.” This code specifically refers to the procedure of making an incision into a peritonsillar abscess to drain it.

3. Procedure

1. The provider prepares the patient for the procedure, ensuring appropriate anesthesia and prepping the area.
2. Using a surgical blade or scalpel, the provider makes an incision into the peritonsillar abscess.
3. The abscess is allowed to open, facilitating drainage of the accumulated purulent material (pus) in the soft tissue.
4. Topical antibiotics may be applied over the surgical site, and packing or closure may be performed if necessary.

4. Qualifying circumstances

CPT 42700 is performed when a patient has a peritonsillar abscess that requires incision and drainage. This procedure is typically performed by a healthcare provider who is appropriately trained and qualified to perform the incision and drainage. The patient must have a documented diagnosis of a peritonsillar abscess, and the procedure must be medically necessary to alleviate symptoms and prevent complications.

5. When to use CPT code 42700

CPT code 42700 should be used when a provider performs the incision and drainage of a peritonsillar abscess. It is important to ensure that the procedure is documented accurately and that the patient’s diagnosis supports the medical necessity of the procedure.

6. Documentation requirements

To support a claim for CPT 42700, the provider must document the following information:

• Patient’s diagnosis of a peritonsillar abscess
• Details of the procedure, including the incision and drainage
• Any additional procedures performed, such as packing or closure
• Use of anesthesia or sedation
• Any complications or adverse events
• Post-procedure instructions or follow-up plans

7. Billing guidelines

When billing for CPT 42700, it is important to ensure that the documentation supports the medical necessity of the procedure. The provider should use the appropriate diagnosis code for a peritonsillar abscess and include any additional procedures or services performed during the same encounter. It is also important to follow any specific billing guidelines provided by the payer or coding guidelines.

8. Historical information

CPT code 42700 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 presents with a peritonsillar abscess, and the provider performs an incision and drainage procedure to alleviate symptoms and facilitate healing.
2. During a tonsillectomy procedure, the provider identifies a peritonsillar abscess and performs an additional incision and drainage to address the abscess.
3. A patient with a history of recurrent peritonsillar abscesses undergoes an incision and drainage procedure to manage the current abscess.
4. Following a diagnosis of a peritonsillar abscess, the provider performs an incision and drainage procedure to prevent complications and promote healing.
5. A patient presents with severe pain and difficulty swallowing, and the provider identifies a peritonsillar abscess requiring immediate incision and drainage.
6. During a routine examination, the provider discovers a peritonsillar abscess and performs an incision and drainage procedure to address the infection.
7. A patient with a peritonsillar abscess undergoes an incision and drainage procedure under local anesthesia to alleviate symptoms and promote healing.
8. Following a course of antibiotics that did not fully resolve the peritonsillar abscess, the provider performs an incision and drainage procedure to ensure complete resolution.
9. A patient with a peritonsillar abscess undergoes an incision and drainage procedure, and the provider applies topical antibiotics to prevent infection.
10. During a tonsillectomy procedure, the provider identifies a peritonsillar abscess and performs an incision and drainage procedure to address the abscess and prevent complications.