How To Use CPT Code 42999

CPT 42999 describes a procedure performed on the pharynx, adenoids, or tonsils that is not covered by any existing codes. 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 42999?

CPT 42999 is used to report an unlisted procedure performed on the pharynx, adenoids, or tonsils that does not have a specific code assigned to it. This code should only be used when there is no other existing code that accurately describes the procedure performed.

2. Official Description

The official description of CPT code 42999 is: ‘Unlisted procedure, pharynx, adenoids, or tonsils.’

3. Procedure

1. The healthcare professional performs a procedure on the pharynx, adenoids, or tonsils that is not covered by any existing codes.
2. The procedure may involve the removal of a Thornwaldt/Tornwaldt cyst or any other procedure that is not addressed by previous codes.
3. Prior authorization should be obtained for the procedure.
4. A detailed description of the procedure should be included with the claim.

4. Qualifying circumstances

CPT 42999 should only be used when there is no other existing code that accurately describes the procedure performed on the pharynx, adenoids, or tonsils. It is important to ensure that the procedure is not covered by any other specific codes before reporting CPT 42999.

5. When to use CPT code 42999

CPT code 42999 should be used when there is no other existing code that accurately describes the procedure performed on the pharynx, adenoids, or tonsils. It is important to thoroughly review the available codes and determine if there is a more specific code that can be used before resorting to CPT 42999.

6. Documentation requirements

To support a claim for CPT 42999, it is important to include the following documentation:

• A detailed description of the procedure performed on the pharynx, adenoids, or tonsils
• Any relevant notes or documentation that can help justify the use of CPT 42999

7. Billing guidelines

When billing for CPT 42999, it is important to include a cover letter explaining the reason for choosing the unlisted code instead of a defined active code. It is also recommended to submit one CPT code whose descriptor approximates the procedure being reported by CPT 42999 to justify the claim amount. Submitting relevant documentation and notes can also strengthen the claim and avoid possible denials.

8. Historical information

CPT 42999 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 professional performs a procedure to remove a Thornwaldt/Tornwaldt cyst from the pharynx.
2. A patient undergoes a procedure on the adenoids that is not covered by any existing codes.
3. A surgeon performs a unique procedure on the tonsils that does not have a specific code assigned to it.
4. A healthcare professional performs a procedure on the pharynx that is not addressed by any previous codes.
5. A patient requires a procedure on the tonsils that is not accurately described by any existing codes.
6. A healthcare professional performs a procedure on the adenoids that is not covered by any specific codes.
7. A surgeon performs a unique procedure on the pharynx that does not have a specific code assigned to it.
8. A patient undergoes a procedure on the tonsils that is not accurately described by any existing codes.
9. A healthcare professional performs a procedure on the pharynx that is not covered by any specific codes.
10. A patient requires a unique procedure on the adenoids that does not have a specific code assigned to it.