CPT code 42825 is used for the surgical removal of tonsils, a common procedure to treat chronic tonsillitis or breathing issues.
CPT code 42825 is for the surgical procedure involving the removal of the tonsils, also known as a tonsillectomy. This code is used to document and bill for the procedure when a healthcare provider performs the surgical excision of the tonsils, typically due to recurrent infections or other related health issues.
For CPT code 42825, which pertains to the removal of tonsils, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session.
3. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: Used if the same procedure is repeated by the same physician.
5. Modifier 77 - Repeat Procedure by Another Physician: Used if the same procedure is repeated by a different physician.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a related procedure is performed during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
8. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these healthcare professionals assist in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 42825 is reimbursed by Medicare. This code is included in the Medicare Physician Fee Schedule (MPFS), which determines the payment rates for covered services. Healthcare providers should consult their local Medicare Administrative Contractor (MAC) for specific coverage guidelines and reimbursement rates, as these may vary by region.
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