How To Use CPT Code 42960

CPT 42960 describes the procedure for controlling oropharyngeal hemorrhage, both primary and secondary, after a surgical procedure such as a tonsillectomy. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 42960?

CPT 42960 can be used to describe the procedure performed by a healthcare provider to control bleeding in the mouth and throat within 24 hours (primary) or from 24 hours up to two weeks (secondary) after a surgical procedure, such as a tonsillectomy. This code is used when the procedure is uncomplicated and does not require hospital admission.

2. Official Description

The official description of CPT code 42960 is: ‘Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); simple.’

3. Procedure

1. The healthcare provider assesses the patient’s condition and determines the need for controlling oropharyngeal hemorrhage.
2. Local anesthesia is applied to the patient.
3. The provider uses simple techniques such as bipolar electrocautery or hot water irrigation with saline to control bleeding in the mouth and throat.
4. Once hemostasis (control of bleeding) is achieved and the patient has recovered, the provider discharges the patient from the outpatient facility.

4. Qualifying circumstances

CPT 42960 is used when the patient continues to bleed or rebleeds following a prior surgical procedure, such as a tonsillectomy. The procedure is considered simple and does not require hospital admission. The provider uses techniques like bipolar electrocautery or hot water irrigation with saline to control bleeding in the mouth and throat.

5. When to use CPT code 42960

CPT code 42960 should be used when a healthcare provider performs the procedure to control oropharyngeal hemorrhage, both primary and secondary, after a surgical procedure like a tonsillectomy. It should not be used for control of bleeding requiring surgical intervention or for post-operative nasopharyngeal bleeding.

6. Documentation requirements

To support a claim for CPT 42960, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for controlling oropharyngeal hemorrhage
• Specific techniques used to control bleeding, such as bipolar electrocautery or hot water irrigation with saline
• Date of the procedure
• Recovery status of the patient
• Discharge from the outpatient facility

7. Billing guidelines

When billing for CPT 42960, ensure that the procedure is performed to control oropharyngeal hemorrhage after a surgical procedure like a tonsillectomy. It should not be reported for control of post-operative oropharyngeal bleeding or post-operative nasopharyngeal bleeding for Medicare payers. Modifier 78 should be appended if the complication occurs during the global period of the original procedure and the patient is returned to the operating room for a related procedure.

8. Historical information

CPT 42960 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient experiences oropharyngeal bleeding within 24 hours after a tonsillectomy, and the healthcare provider uses bipolar electrocautery to control the bleeding.
2. A patient develops secondary oropharyngeal hemorrhage one week after a tonsillectomy, and the provider performs hot water irrigation with saline to achieve hemostasis.
3. Following a tonsillectomy, a patient continues to bleed, and the provider uses bipolar electrocautery to control the oropharyngeal hemorrhage.
4. A patient presents with oropharyngeal bleeding two weeks after a tonsillectomy, and the provider performs hot water irrigation with saline to stop the bleeding.
5. After a tonsillectomy, a patient experiences rebleeding in the oropharynx, and the provider uses bipolar electrocautery to achieve hemostasis.
6. A patient develops secondary oropharyngeal hemorrhage within 24 hours after a tonsillectomy, and the provider performs hot water irrigation with saline to control the bleeding.
7. Following a tonsillectomy, a patient continues to bleed, and the provider uses bipolar electrocautery to control the oropharyngeal hemorrhage.
8. A patient presents with oropharyngeal bleeding one week after a tonsillectomy, and the provider performs hot water irrigation with saline to stop the bleeding.
9. After a tonsillectomy, a patient experiences rebleeding in the oropharynx, and the provider uses bipolar electrocautery to achieve hemostasis.
10. A patient develops secondary oropharyngeal hemorrhage within 24 hours after a tonsillectomy, and the provider performs hot water irrigation with saline to control the bleeding.