How To Use CPT Code 42800

CPT 42800 describes the procedure of obtaining a biopsy sample from the oropharynx, which is the part of the throat located behind the mouth. This article will provide an overview of CPT code 42800, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 42800?

CPT 42800 is used to describe the biopsy procedure in which a small tissue sample is obtained from the oropharynx, which is situated behind the oral cavity. This code is specifically used when the provider excises a sample from the oropharynx for diagnostic analysis.

2. Official Description

The official description of CPT code 42800 is: ‘Biopsy; oropharynx.’

3. Procedure

1. The provider ensures that the patient is appropriately prepped and anesthetized for the procedure.
2. To ensure the patient’s ability to breathe during the procedure, the provider may use an endotracheal tube.
3. The provider then excises a small tissue sample from the oropharynx, which is located behind the oral cavity.
4. The obtained sample is sent for diagnostic analysis to ascertain the presence of any disease or condition.

4. Qualifying circumstances

CPT code 42800 is used when the provider obtains a biopsy sample from the oropharynx. This procedure is typically performed when there is a suspicion of a disease or condition in the oropharynx that requires further diagnostic analysis. It is important to note that the provider must ensure the patient’s ability to breathe during the procedure, and the sample obtained is sent for diagnostic analysis.

5. When to use CPT code 42800

CPT code 42800 should be used when the provider performs a biopsy procedure to obtain a tissue sample from the oropharynx. This code is appropriate when there is a need for further diagnostic analysis of the oropharynx, and the provider excises a sample for that purpose.

6. Documentation requirements

To support a claim for CPT code 42800, the provider must document the following information:

• The reason for performing the biopsy procedure on the oropharynx
• Details of the prepping and anesthesia provided to the patient
• The use of an endotracheal tube, if applicable
• The date and time of the procedure
• A description of the tissue sample obtained
• Documentation of sending the sample for diagnostic analysis

7. Billing guidelines

When billing for CPT code 42800, ensure that the procedure performed is a biopsy of the oropharynx. It is important to accurately document the details of the procedure and provide the necessary supporting documentation. Additionally, be aware of any specific guidelines or requirements from the payer regarding the reporting of this code.

8. Historical information

CPT code 42800 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 provider performs a biopsy of the oropharynx to obtain a tissue sample for further analysis.
2. During the procedure, the provider ensures the patient’s ability to breathe by using an endotracheal tube.
3. The obtained tissue sample is sent for diagnostic analysis to determine the presence of any disease or condition in the oropharynx.
4. A patient presents with symptoms suggestive of oropharyngeal cancer, and the provider performs a biopsy to confirm the diagnosis.
5. A provider performs a biopsy of the oropharynx to investigate the cause of persistent throat pain in a patient.
6. During the procedure, the provider carefully excises a tissue sample from the oropharynx using specialized instruments.
7. The obtained tissue sample is sent to the laboratory for histopathological examination.
8. A patient with a suspected infection in the oropharynx undergoes a biopsy procedure to identify the causative organism.
9. The provider performs the biopsy using sterile techniques to ensure accurate results.
10. The obtained tissue sample is cultured to determine the presence of any bacterial or fungal infection.