Q. What are the appropriate codes to report when a physician performs a nasal endoscopy and obtains multiple biopsies of the nasopharyngeal tissue in conjunction with a tonsillectomy and adenoidectomy (T&A)?
A. The physician should report only the appropriate T & A code based on the patients age. Since an adenoidectomy removes nasopharyngeal tissue, do not report the endoscopy or mirror visualization of the nasopharynx with biopsy separately.
If the nasopharyngoscopy is endoscopically performed without adenoidectomy, report 92511 – Nasopharyngoscopy with endoscope (separate procedure); if endoscopic nasopharyngoscopy is performed with biopsy(ies), report 42999 – Unlisted procedure, pharynx, adenoids, or tonsils. Open biopsies of the nasopharynx are reported with 42804 – Biopsy; nasopharynx, visible lesion, simple or 42806 – Biopsy; nasopharynx, survey for unknown primary lesion.
Revised October 2010
Approved June 2010
Important Disclaimer Notice (Updated 8/7/14)
CPT for ENT articles are a collaborative effort between the Academy’s team of CPT Advisors, members of the Physician Payment Policy (3P) workgroup, and health policy staff. Articles are developed to address common coding questions received by the health policy team, as well as to clarify coding changes and correct coding principles for frequently reported ENT procedures. These articles are not intended as legal, medical, or business advice and are not a guarantee of reimbursement. The information is also not meant to serve as the definitive or sole authority on billing and coding issues. The applicability of AAO-HNS billing and coding guidance for a particular procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. You should consult with your own advisors as well as Medicare or private carriers in making any decisions about how to bill and code particular services or procedures.