Refresh Your Coding Understanding of These Common Pediatric Oral Surgeries
Here’s all the procedure codes you’ll need, with all the Dx codes that go with them. Your office may see a lot of oral surgeries involving pediatric patients, but just because they are common doesn’t mean you’re coding them right. So, here’s your chance to double-check your work and make sure you have all of your coding ducks in a row for these frequently performed pediatric otolaryngology encounters. Don’t Tie Up Your Tongue and Lip Procedure Claims Some children are born tongue-tied (ankyloglossia) or lip-tied. A tongue-tie occurs when the lingual frenulum, the tissue that connects the tongue to the floor of the mouth, is too short or tight, restricting the tongue’s movement. A lip-tie occurs when the labial frenulum, the tissue that connects the upper lip to the gums, is too short, thick or tight restricting the lip’s movement. Both tongue-tie and lip-tie can cause issues with breastfeeding and speech. Relevant Procedure Codes If your surgeon performs a frenotomy, you will have to report the code for incision of the frenum. Based on anatomical location, you have to report these two codes when your clinician performs a frenotomy: The procedure described in 41010 refers to a simple cut or snip of the frenum. If the patient chart notes read that your surgeon performed a frenectomy, you will have to report an excision code. Again, depending on the anatomical location, you will have to choose from one of the following two codes for an excision of the frenum: The procedure described in 41115 includes a simple repair or closure. But if the patient has a short or tight frenum, the surgeon may perform a frenoplasty. This requires intermediate or complex closure, and is reported with 41520 (Frenoplasty (surgical revision of frenum, eg, with Z-plasty)). Remember for tongue and lip procedures, a little knowledge of medical terminology goes a long way: Relevant Dx Codes You’ll report Q18.9 (Congenital malformation of face and neck, unspecified) when your surgeon operates on the labial frenum and Q38.1 (Ankyloglossia) when your surgeon performs a surgical procedure on the lingual frenum. Open Up to This Tonsil and Adenoid Procedure Advice Correctly coding the tonsil or adenoid removal procedures listed below is based on three things: whether the tonsils or adenoids or both are removed; the patient’s age; and if this is a primary or secondary procedure, which refers to a second surgical removal because portions of the structure were missed during the primary surgery, or some of the tissue has grown back. Relevant Procedure Codes Remember These Modifiers When your surgeon removes tonsils and/or adenoids on both sides, avoid the urge to append modifier 50 (Bilateral procedure). The modifier does not apply to tonsillectomy and adenoidectomy codes because the codes are inherently bilateral. However, if your ENT performs a unilateral tonsillectomy and/or adenoidectomy, you should report the appropriate code with modifier 52 (Reduced services) appended, per CPT® Assistant (February 1998). Modifier 52 also applies to procedure codes 42820, 42821, 42825, and 42826 if only partial ablation of tonsil tissue is achieved. Note, too, that the combination codes 42820 and 42821 don’t distinguish between primary and secondary. If the surgeon performs a tonsillectomy and adenoidectomy at the same session, you must use the age-appropriate combination code, regardless of whether the procedure on either structure is primary or secondary. Also, watch for National Correct Coding Initiative (NCCI) edits, which reinforce the importance of paying attention to the patient’s age. The bundled codes for tonsillectomies and adenoidectomies include each of the age pairs (either under age 12, or age 12 and over). Relevant Dx Codes Cling to This Cleft Lip Advice Cleft lips and cleft palates are birth defects where the upper lip does not completely close during fetal development, resulting in a split in the upper lip, the palate (roof of the mouth), or both. Relevant Procedure Codes The most common cleft lip and/or palate repair codes are: Per the code descriptors, you’ll use 40701 and 40702 for bilateral procedures, with 40702 reserved for cleft lip repairs when the surgeon performs one stage of a two-stage procedure. If one of these cleft lip and/or nasal deformity primary repairs does not deliver favorable results, the provider may reopen the defect and reclose the surgical site, which you’ll report with 40720 (Plastic repair of cleft lip/nasal deformity; secondary, by recreation of defect and reclosure). Other related codes include: Relevant Dx Codes You’ll report codes from Q35.- (Cleft palate), Q36.- (Cleft lip), or a combination code from Q37.- (Cleft palate with cleft lip) as appropriate. But pay careful attention to your provider’s notes, as Q36.- and Q37.- codes feature laterality information (unilateral, bilateral, and median in the case of Q36.1), and the Q35.- and Q37.- codes distinguish between hard, soft, and both hard and soft palates. Lori Carlin, CPC, COC, CPCO, CRC, CCS, Principal-Professional Audit, Coding & Education Services and Angie Wood,
CPC, Senior Physician Auditor/Educator, Pinnacle Enterprise Risk Consulting Services
