How To Use CPT Code 42806

CPT 42806 describes the procedure for obtaining a biopsy from a patient with an unknown primary lesion of the nasopharynx. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 42806?

CPT 42806 can be used to describe the procedure in which a healthcare provider obtains a biopsy from a patient with an unknown primary lesion of the nasopharynx. This code is used when the provider needs to survey for a primary lesion that has not yet been identified. It is important to note that CPT 42806 is specifically for obtaining a biopsy from an unknown primary lesion, not from a visible lesion of the nasopharynx.

2. Official Description

The official description of CPT code 42806 is: ‘Biopsy; nasopharynx, survey for unknown primary lesion.’

3. Procedure

1. The healthcare provider ensures that the patient is appropriately prepped and anesthetized for the procedure.
2. To ensure the patient can breathe during the procedure, the provider may use an endotracheal tube.
3. The provider removes tissue from the nasopharynx using a biopsy technique.
4. This biopsy is part of a survey to identify the primary lesion that has not yet been identified.
5. Careful attention is given to obtaining an adequate tissue sample for further analysis.

4. Qualifying circumstances

CPT 42806 is used when a healthcare provider needs to obtain a biopsy from a patient with an unknown primary lesion of the nasopharynx. This procedure is typically performed when previous biopsies have shown that the patient has metastatic cancerous lesions, but the site of the primary cancerous lesion is not yet known. It is important to note that CPT 42806 should not be used for obtaining a biopsy from a visible lesion of the nasopharynx, as there is a separate code (CPT 42804) for that specific procedure.

5. When to use CPT code 42806

CPT code 42806 should be used when a healthcare provider needs to obtain a biopsy from a patient with an unknown primary lesion of the nasopharynx. It is important to ensure that the primary lesion has not yet been identified before using this code. If the biopsy is being performed on a visible lesion of the nasopharynx, a different code (CPT 42804) should be used instead.

6. Documentation requirements

To support a claim for CPT 42806, the healthcare provider must document the following information:

• The reason for performing the biopsy, including the presence of metastatic cancerous lesions and the unknown primary lesion
• The specific technique used to obtain the biopsy
• The date and time of the procedure
• Any additional details or findings related to the biopsy
• The provider’s signature

7. Billing guidelines

When billing for CPT 42806, it is important to ensure that the procedure is performed for a patient with an unknown primary lesion of the nasopharynx. This code should not be reported if the biopsy is being performed on a visible lesion of the nasopharynx. It is also important to follow any specific guidelines or requirements set by the payer or insurance company. Additionally, it is important to consider any applicable modifiers or additional codes that may be required for accurate billing.

8. Historical information

CPT 42806 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 healthcare provider performs a biopsy on a patient with metastatic cancerous lesions, but the primary lesion in the nasopharynx is unknown.
2. A patient undergoes a biopsy procedure to survey for an unknown primary lesion in the nasopharynx after previous biopsies have shown metastatic cancerous lesions.
3. A healthcare provider obtains a biopsy from the nasopharynx of a patient with an unknown primary lesion to aid in the identification of the primary cancerous lesion.
4. A biopsy is performed on a patient with metastatic cancerous lesions to survey for an unknown primary lesion in the nasopharynx.
5. A healthcare provider obtains a biopsy from the nasopharynx of a patient with an unknown primary lesion, as part of the investigation into the source of the metastatic cancerous lesions.
6. A patient undergoes a biopsy procedure to survey for an unknown primary lesion in the nasopharynx, following previous biopsies that have shown metastatic cancerous lesions.
7. A healthcare provider performs a biopsy on a patient with metastatic cancerous lesions, aiming to identify the primary lesion in the nasopharynx.
8. A biopsy is obtained from the nasopharynx of a patient with an unknown primary lesion, as part of the diagnostic process for metastatic cancerous lesions.
9. A healthcare provider performs a biopsy on a patient with metastatic cancerous lesions, in an effort to identify the primary lesion in the nasopharynx.
10. A patient undergoes a biopsy procedure to survey for an unknown primary lesion in the nasopharynx, following previous biopsies that have shown metastatic cancerous lesions.