Clinical Indicators
Adenoidectomy
| Procedure |
CPT |
FUD |
| Adenoidectomy, primary; under age 12 |
42830 |
90 |
| Adenoidectomy, primary; age 12 or over |
42831 |
90 |
| Adenoidectomy, secondary; under age 12 |
42835 |
90 |
| Adenoidectomy secondary; age 12 or over |
42836 |
90 |
Indications
1. History... (One required)
| a) |
Four or greater episodes of recurrent purulent rhinorrhea in
prior 12 months in a child <12 years of age. One episode should be
documented by intranasal examination or diagnostic imaging. |
| b) |
Persisting symptoms of adenoiditis after two courses of
antibiotic therapy. One course of antibiotics should be with a B-lactamase
stable antibiotic for at least two weeks. |
| c) |
Sleep disturbance with nasal airway obstruction persisting for
at least 3 months. |
| d) |
Hyponasal or nasal speech. |
| e) |
Otitis media with effusion >3 months/second set of tubes.
|
| f) |
Dental malocclusion or orofacial growth disturbance documented
by orthodontist. |
| g) |
Cardiopulmonary complications including cor pulmonale,
pulmonary hypertension, right ventricular hypertrophy associated with upper
airway obstruction. |
| h) |
Otitis media with effusion ($age 4). |
For infectious conditions, it is recommended that documentation of
infections be obtained. For hypertrophy and other noninfectious conditions
documentation should include information regarding growth, weight gain, any
medical condition necessitating removal of the adenoids. Adenoid size is
immaterial when the indication is sinusitis, adenoiditis, or otitis media with
effusion. Allergic symptoms should have been treated with an adequate trial of
allergy therapy prior to evaluation for non-infectious conditions.
2. Physical Examination... (required)
| a) |
Description of uvula, palate, tonsils, nasal airway, cervical
lymph nodes.
|
| b) |
Evaluation of adenoids by mirror, palpation or imaging as
necessary. |
3. Tests... (If abnormality suspected by history, physical
examination)
| a) |
Coagulation and bleeding evaluation
|
| b) |
Radiographs (lateral neck or cephalometric)
|
| c) |
Sleep tape recording (if documentation of snoring or apnea
required)
|
| d) |
Polysomnography (if required) |
Postoperative Observations
| 1. |
Bleeding from nose, mouth or emesis of fresh blood-notify
surgeon.
|
| 2. |
Hydration maintained by IV until oral intake satisfactory.
|
| 3. |
Adequate pain control maintained postoperatively using oral or
IM. medications depending on oral intake.
|
| 4. |
Persistent temperature >102 degrees F - notify surgeon.
|
Outcome Review
1. Two-Four Week
| a) |
Healing - Did patient require treatment for bleeding,
infections, or dehydration?
|
| b) |
Function - Is there a change in voice, breathing, or swallowing
from the preoperative status?
|
2. One Year
| a) |
Infection - Have there been fewer throat infections, or ear
infections, if applicable?
|
| b) |
Function - Is breathing improved? |
Associated ICD-9 Diagnostic Codes
| 474.9 |
Chronic adenotonsillitis |
| 474.12 |
Adenoid hypertrophy |
| 474.1 |
Adenoid and tonsil hypertrophy |
| 780.51 |
Sleep apnea |
| 786.09 |
Snoring |
| 473.9 |
Chronic Sinusitis, NOS |
| 524.4 |
Malocclusion |
| 474.01 |
Chronic Adenoiditis |
Related ICD-9 Codes
| 381.20 |
Chronic mucoid otitis media, simple or
unspecified |
| 382.10 |
Chronic tubotympanic suppurative otitis media |
| 382.20 |
Chronic atticoantral otitis media |
| 385.11 |
Adhesion of drum head to incus |
| 385.12 |
Adhesion of drum head to stapes |
| 385.13 |
Adhesion of drum head to promontorium |
| 385.19 |
Other adhesion and combinations |
Additional Information
Assistant Surgeon -- N
Supply Charges -- N
Prior Approval -- N
Anesthesia Code(s)
00160
Patient Information
Removal of adenoids is one of the most frequently performed throat operations.
It offers a safe, effective surgical way to resolve breathing obstruction,
throat infections and manage recurrent childhood ear disease. Pain following
surgery is an unpleasant side effect, but can be reasonably controlled with
medication. Similar to the pain experienced with throat infections, it may
often also be felt in the ears. There are also some risks associated with
removal of adenoids. Although very rare, significant postoperative bleeding may
occur. If significant bleeding occurs, it is most often immediate and short
lived. Treatment of such bleeding is usually handled as an outpatient, however,
susutained bleeding may require treatment in the operating room under general
anesthesia. In rare cases, a blood transfusion may be recommended. There are
some more persistent side effects sometimes associated with the removal of
adenoids. As swallowing is painful after surgery, the patient may not take in
sufficient fluids orally. If this cannot be corrected at home, IV fluid
replacement may be necessary. Halitosis is common in the immediate
postoperative period. Infection is an infrequent occurrence. Anesthetic
complications are known to exist, however, they are quite uncommon.
Important Notice
The Clinical Indicators for Otolaryngology--Head and Neck Surgery
are guidelines only. In no sense do they represent a standard of care. The
applicability of an indicator for a procedure, and/or of the process or outcome
criteria, must be determined by the responsible physician in light of all the
circumstances presented by the individual patient. Adherence to these
guidelines will not ensure successful treatment in every situation. The
American Academy of Otolaryngology-Head and Neck Surgery, Inc. emphasizes that
these clinical indicators should not be deemed inclusive of all proper
treatment decisions or methods of care, nor exclusive of other treatment
decisions or methods of care reasonably directed to obtaining the same results.
© 2000 American Academy of Otolaryngology-Head and Neck Surgery.
One Prince Street, Alexandria, VA 22314.
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