Looking for Tonsil Biopsy Code?

September 25, 2009

Question: My physician did a punch excisional biopsy of the left tonsil, but I’m not seeing a code for this. What should I do?

Answer: You don’t see a code, because no specific code exists for a biopsy of the tonsils.

You should instead report the code based on whether the otolaryngologist used a scope. If he didn’t, you should assign 42800 (Biopsy; oropharynx).

If the physician used an endoscope, you should report 31535 (Laryngoscopy, direct, operative, with biopsy) or 31536 (… with operating microscope).

Note: CPT classifies “indirect” laryngoscopy as an endoscopy, even though the procedure requires a mirror, not an endoscope.

ASC Coding & Reimbursement Conference. This December 6-8 in Orlando.

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