How To Use CPT Code 42962

CPT 42962 describes the surgical intervention used to control oropharyngeal hemorrhage, either primary or secondary, within 24 hours or up to two weeks after a surgery 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 42962?

CPT 42962 can be used to describe the surgical intervention performed by a healthcare provider to control bleeding in the mouth and throat within a specific timeframe after a surgery, such as a tonsillectomy. This code is used when the provider uses surgical methods, such as suture ligature technique, bipolar electrocautery, hot water irrigation, or chemicals like epinephrine, Avitene®, Floseal®, and levonordefrin, to achieve hemostasis and control the bleeding.

2. Official Description

The official description of CPT code 42962 is: ‘Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); with secondary surgical intervention.’

3. Procedure

1. After appropriate anesthesia, the healthcare provider performs a surgical intervention to control heavy bleeding in the mouth and pharynx.
2. The provider may use techniques such as suture ligature, bipolar electrocautery, hot water irrigation, or chemicals like epinephrine, Avitene®, Floseal®, and levonordefrin to achieve hemostasis.
3. The procedure aims to stop the uncontrolled, rapid, and excessive bleeding in the oropharynx.
4. The intervention may involve sealing or destruction of tissues using high-frequency electrical current (electrocautery).

4. Qualifying circumstances

CPT 42962 is used when a healthcare provider performs a surgical intervention to control oropharyngeal hemorrhage, either primary or secondary, within a specific timeframe after a surgery. This code is applicable when the bleeding occurs within 24 hours (primary) or up to two weeks (secondary) after a procedure, such as a tonsillectomy. The procedure is performed to achieve hemostasis and control the bleeding in the mouth and throat.

5. When to use CPT code 42962

CPT code 42962 should be used when a healthcare provider performs a surgical intervention to control oropharyngeal hemorrhage within the specified timeframe after a surgery. This code is not appropriate for simple control of oropharyngeal bleeding that does not require hospitalization or for complicated control requiring hospitalization but not surgical intervention. It is important to accurately document the timing and nature of the bleeding to support the use of this code.

6. Documentation requirements

To support a claim for CPT 42962, the healthcare provider must document the following information:

• Description of the surgical intervention performed to control oropharyngeal hemorrhage
• Date and time of the procedure
• Details of the bleeding, including whether it is primary or secondary and the timeframe after the surgery
• Techniques used to achieve hemostasis, such as suture ligature, bipolar electrocautery, hot water irrigation, or the use of specific chemicals
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the surgical intervention

7. Billing guidelines

When billing for CPT 42962, ensure that the surgical intervention is performed to control oropharyngeal hemorrhage within the specified timeframe after a surgery. It is important to accurately document the details of the procedure and the bleeding to support the use of this code. CPT 42962 should not be reported for post-operative oropharyngeal bleeding or post-operative nasopharyngeal bleeding for Medicare payers, as these are typically considered part of the global period of the original procedure. It is recommended to review the specific payer guidelines for accurate billing.

8. Historical information

CPT 42962 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 healthcare provider performs a surgical intervention to control oropharyngeal hemorrhage within 24 hours after a tonsillectomy.
2. Using bipolar electrocautery, a provider achieves hemostasis and controls bleeding in the mouth and throat of a patient who experienced secondary hemorrhage two weeks after a tonsillectomy.
3. After appropriate anesthesia, a provider uses the suture ligature technique to control bleeding in the oropharynx following a surgical procedure.
4. A healthcare provider performs a surgical intervention to control primary oropharyngeal hemorrhage within 24 hours after a surgery other than a tonsillectomy.
5. Using hot water irrigation, a provider achieves hemostasis and controls bleeding in the mouth and throat of a patient who experienced secondary hemorrhage within the specified timeframe after a surgery.
6. After appropriate anesthesia, a provider uses chemicals like Floseal® to achieve hemostasis and control bleeding in the oropharynx following a surgical procedure.
7. A healthcare provider performs a surgical intervention to control oropharyngeal hemorrhage within two weeks after a tonsillectomy.
8. Using bipolar electrocautery, a provider achieves hemostasis and controls bleeding in the mouth and throat of a patient who experienced secondary hemorrhage within the specified timeframe after a surgery other than a tonsillectomy.
9. After appropriate anesthesia, a provider uses the suture ligature technique to control bleeding in the oropharynx following a surgical procedure other than a tonsillectomy.
10. A healthcare provider performs a surgical intervention to control primary oropharyngeal hemorrhage within two weeks after a surgery other than a tonsillectomy.