December 11, 2014
Can you tell me if in fact the tonsillectomy code is bundled into the UPPP code? We are having an argument about that in our office and would appreciate it if you’d weigh in.
That’s a very good question. From a CPT coding standpoint, the tonsillectomy code may be separately reported from the UPPP.
Here is a Q&A from the August 1997 CPT Assistant:
At the same surgical session, my physician performed a palato-pharyngoplasty and a tonsillectomy. Can both of these services be reported, or is the tonsillectomy part of the palatopharyngoplasty?
From a CPT coding perspective, the tonsillectomy is a separate and distinct procedure. Therefore, if the physician performs a palato-pharyngoplasty and a tonsillectomy, both services would be reported. In this instance, the modifier -51 should be appended to the secondary or additional procedure to indicate that multiple procedures were performed on the same day or at the same surgical session by the same physician.”
While CPT may allow separate reporting of the tonsillectomy code, many payors, including Medicare, bundle payment of the tonsillectomy into the UPPP.