How To Use CPT Code 42971

CPT 42971 describes the procedure for controlling nasopharyngeal hemorrhage, either primary or secondary, that requires hospitalization. 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 42971?

CPT 42971 involves the use of various techniques to control bleeding in the nasal part of the pharynx (throat) within 24 hours after surgery, such as an adenoidectomy. This code is used when the bleeding is severe and life-threatening, requiring immediate hospitalization of the patient. The provider may utilize methods like bipolar electrocautery, hot water irrigation, or the application of specific chemicals to achieve hemostasis (control of bleeding).

2. Official Description

The official description of CPT code 42971 is: ‘Control of nasopharyngeal hemorrhage, primary or secondary (e.g., postadenoidectomy); complicated, requiring hospitalization.’

3. Procedure

1. The patient is appropriately anesthetized to ensure comfort and safety during the procedure.
2. The provider uses various techniques such as bipolar electrocautery, hot water irrigation, or the application of specific chemicals to control the bleeding in the nasal part of the pharynx.
3. The goal is to achieve hemostasis and stop the bleeding, which may be life-threatening if left uncontrolled.
4. In some cases, extensive blood loss or the inability to achieve control in the provider’s office necessitates hospitalization of the patient.

4. Qualifying circumstances

CPT 42971 is used when the nasopharyngeal bleeding occurs within 24 hours (primary) or up to two weeks (secondary) after surgery, such as an adenoidectomy. Hospitalization is required due to extensive blood loss or because control could not be achieved in the provider’s office. The procedure is performed to address severe bleeding that poses a significant risk to the patient’s life.

5. When to use CPT code 42971

CPT code 42971 should be used when the provider needs to control severe nasopharyngeal bleeding that requires immediate hospitalization. This code is not appropriate for cases where the bleeding can be managed in the provider’s office or does not pose a life-threatening risk to the patient.

6. Documentation requirements

To support a claim for CPT 42971, the provider must document the following information:

• Description of the severe bleeding and the need for immediate hospitalization
• Details of the techniques used to achieve hemostasis, such as bipolar electrocautery, hot water irrigation, or the application of specific chemicals
• Date and time of the procedure
• Extent of blood loss and the effectiveness of the intervention
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 42971, ensure that the procedure meets the qualifying circumstances, including the requirement for hospitalization due to severe bleeding. It is important to accurately document the details of the procedure and provide the necessary supporting documentation. Additionally, be aware of any specific guidelines or requirements from insurance payers regarding the use of this code.

8. Historical information

CPT 42971 was added to the Current Procedural Terminology system on January 1, 1990. In 2017, it was also added to the Inpatient Only (IPO) list for Medicare payers.

9. Examples

1. A patient undergoes an adenoidectomy and experiences severe nasopharyngeal bleeding within 24 hours, requiring immediate hospitalization. The provider utilizes bipolar electrocautery to achieve hemostasis and control the bleeding.
2. Following an adenoidectomy, a patient develops secondary nasopharyngeal bleeding two weeks later. The bleeding is severe and cannot be controlled in the provider’s office, necessitating hospitalization. The provider uses hot water irrigation to achieve hemostasis.
3. After an adenoidectomy, a patient experiences extensive blood loss due to uncontrolled nasopharyngeal bleeding. The provider applies specific chemicals, such as Avitene® and Floseal®, to achieve hemostasis and stop the bleeding. Hospitalization is required to monitor the patient’s condition.
4. A patient undergoes an adenoidectomy, and within 24 hours, severe nasopharyngeal bleeding occurs. The provider utilizes bipolar electrocautery and levonordefrin to achieve hemostasis and control the bleeding. Immediate hospitalization is necessary due to the extent of blood loss.
5. Following an adenoidectomy, a patient experiences secondary nasopharyngeal bleeding two weeks later. The bleeding is severe and cannot be controlled in the provider’s office. The provider uses hot water irrigation and epinephrine to achieve hemostasis and stop the bleeding. Hospitalization is required to manage the patient’s condition.