tci Part B Insider - 2015 Issue 26

Part B Coding Coach: Avoid Bundling Pitfalls for Clean Tonsillectomy Claims

Take this modifier 50 tip to the bank. When billing tonsillectomy and/or adenoidectomy, you need to avoid some common mistakes if you want to get payment for your surgeon’s work. With age factors, combination codes, bilateral issues, bundling restrictions, and possible post-op bleeding, you have a lot to consider if you want to code your surgeon’s work correctly. Read on for steps you can take to sort it all out. Determine Patient’s Age Both tonsillectomy and adenoidectomy codes divide among two age groups: under 12 years, or age 12 and over, as follows: 42820 —Tonsillectomy...

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