How To Use CPT Code 42831

CPT 42831 describes the excision of adenoids in patients who are 12 years of age or older. 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 42831?

CPT 42831 is used to describe the excision of adenoids in patients who are 12 years of age or older. This procedure involves the removal of the lymphoid tissue located above the tonsils, known as adenoids. The excision is performed by a healthcare provider using various techniques such as curette, biting forceps, cryoablation, laser ablation, or electrocautery. The purpose of this procedure is to alleviate symptoms and improve the patient’s overall health.

2. Official Description

The official description of CPT code 42831 is the excision of adenoids in patients who are 12 years of age or older. This code should be used for the initial adenoidectomy procedure. It is important to note that this code does not include the excision of tonsils or any other additional procedures.

3. Procedure

1. The patient is prepared for the procedure, which includes administration of anesthesia and sterile draping.
2. A mouth gag is inserted to provide access to the adenoids.
3. The healthcare provider uses an adenoid curette or biting forceps to remove the adenoid tissues.
4. The removal of adenoids is confirmed using a laryngeal mirror.
5. Bleeding is controlled using electrocautery or other appropriate methods.

4. Qualifying circumstances

CPT 42831 is performed on patients who are 12 years of age or older and require the excision of adenoids. Adenoidectomy may be necessary for various reasons, such as recurrent infections, obstructive sleep apnea, or chronic sinusitis. The procedure is typically performed by an otolaryngologist or an ENT specialist.

5. When to use CPT code 42831

CPT code 42831 should be used when a patient who is 12 years of age or older undergoes an adenoidectomy as the primary procedure. It is important to ensure that the patient meets the age requirement and that the procedure is specifically focused on the excision of adenoids. If the procedure involves the excision of both tonsils and adenoids, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT code 42831, the healthcare provider must document the following information:

• Patient’s age and indication for adenoidectomy
• Details of the procedure, including the technique used
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the healthcare provider

7. Billing guidelines

When billing for CPT code 42831, it is important to ensure that the procedure meets the criteria for this specific code. The excision of adenoids should be the primary focus of the procedure, and it should be performed on a patient who is 12 years of age or older. If additional procedures, such as tonsillectomy, are performed, a different CPT code should be used. It is also important to follow the specific guidelines and requirements of the insurance provider when submitting the claim.

8. Historical information

CPT code 42831 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to this code since its addition.

9. Examples

1. A 14-year-old patient undergoes an adenoidectomy to alleviate symptoms of chronic sinusitis.
2. An otolaryngologist performs an adenoidectomy on a 16-year-old patient with obstructive sleep apnea.
3. A 20-year-old patient undergoes an adenoidectomy to address recurrent infections.
4. A healthcare provider performs an adenoidectomy on a 30-year-old patient with chronic sinusitis.
5. An ENT specialist performs an adenoidectomy on a 25-year-old patient with obstructive sleep apnea.
6. A 40-year-old patient undergoes an adenoidectomy to alleviate symptoms of chronic sinusitis.
7. An otolaryngologist performs an adenoidectomy on a 35-year-old patient with recurrent infections.
8. A 50-year-old patient undergoes an adenoidectomy to address symptoms of chronic sinusitis.
9. A healthcare provider performs an adenoidectomy on a 60-year-old patient with obstructive sleep apnea.
10. An ENT specialist performs an adenoidectomy on a 55-year-old patient with recurrent infections.