How To Use CPT Code 42842

CPT 42842 describes the radical resection of the tonsils, tonsillar pillars, and/or retromolar trigone without closure. This article will cover the description, official terminology, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 42842?

CPT 42842 involves the surgical removal of the tonsils, tonsillar pillars, and/or retromolar trigone without closure. This procedure is typically performed to remove cancerous growths or diseased tissue. It is considered a radical resection, meaning that it includes the removal of the structure, its vascular supply, associated lymph nodes, and surrounding tissues to ensure complete removal of the affected area.

2. Official Description

The official description of CPT code 42842 is: ‘Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; without closure.’

3. Procedure

1. The patient is placed under anesthesia.
2. The physician makes an incision at the neck region to access the tonsils, tonsillar pillars, and/or retromolar trigone.
3. The affected structures are carefully removed, and nearby structures, such as lymph nodes, may also be removed if necessary.
4. If portions of the maxilla or mandible are affected, they may also be removed during the procedure.
5. The resulting wound is left open and will be grafted during a later procedure.

4. Qualifying circumstances

CPT 42842 is performed on patients who require the radical resection of the tonsils, tonsillar pillars, and/or retromolar trigone. This procedure is typically indicated for the removal of cancerous growths or extensive diseased tissue. It is important to note that this procedure does not involve closure of the wound, as it will be grafted during a subsequent procedure.

5. When to use CPT code 42842

CPT code 42842 should be used when a radical resection of the tonsils, tonsillar pillars, and/or retromolar trigone is performed without closure. It is important to accurately document the procedure and ensure that the patient meets the qualifying circumstances for this code.

6. Documentation requirements

To support a claim for CPT 42842, the following documentation is required:

• Patient’s diagnosis necessitating the radical resection
• Details of the procedure, including the specific structures removed
• Any additional structures removed, such as lymph nodes
• Documentation of the decision not to perform closure
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 42842, ensure that the procedure meets the criteria for a radical resection without closure. It is important to accurately document the procedure and provide the necessary supporting documentation. Additionally, be aware of any specific guidelines or requirements from the payer regarding the use of this code.

8. Historical information

CPT 42842 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 undergoes a radical resection of the tonsils and tonsillar pillars without closure to remove a cancerous growth.
2. A physician performs a radical resection of the retromolar trigone without closure to remove diseased tissue.
3. A patient with extensive tonsil infection undergoes a radical resection of the tonsils, tonsillar pillars, and retromolar trigone without closure.
4. A surgeon removes cancerous growths from the tonsils and retromolar trigone without closure during a radical resection procedure.
5. A patient with a history of recurrent tonsil infections undergoes a radical resection of the tonsils and tonsillar pillars without closure.
6. A physician performs a radical resection of the retromolar trigone without closure to remove a large tumor.
7. A patient with extensive tonsil stones undergoes a radical resection of the tonsils and tonsillar pillars without closure.
8. A surgeon removes cancerous growths from the tonsils and retromolar trigone without closure during a radical resection procedure.
9. A patient with a history of recurrent tonsil infections undergoes a radical resection of the tonsils and tonsillar pillars without closure.
10. A physician performs a radical resection of the retromolar trigone without closure to remove a large tumor.