Summary & Overview
CPT 42835: Recurrent or Secondary Adenoidectomy in Children
CPT code 42835 designates a recurrent or secondary adenoidectomy for patients under 12 years of age. This pediatric otolaryngology surgical code matters nationally because repeat adenoidectomy addresses persistent or recurrent nasal obstruction, infections, or sleep-disordered breathing after an initial procedure. Understanding how 42835 is billed and reimbursed affects hospital outpatient departments, ambulatory surgery centers, and pediatric ENT practices delivering follow-up surgical care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for repeat adenoidectomy, typical sites of service, and the service type. The publication summarizes common billing considerations, including frequently applied modifiers and national reimbursement patterns where available. It also highlights policy and coding guidance relevant to documenting a secondary adenoidectomy and distinguishes this code from primary adenoidectomy codes.
This executive summary is intended for national audiences—health system coders, billing staff, pediatric otolaryngologists, and payer policy analysts—seeking a clear briefing on the purpose of CPT code 42835, the clinical scenario it represents, and the topics covered in the full publication.
Billing Code Overview
CPT code 42835 describes a recurrent or secondary adenoidectomy performed in a patient who is less than 12 years old. This procedure involves surgical removal of adenoid tissue following a prior adenoidectomy when symptoms or pathology recur.
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Service type: Surgical, otolaryngology procedure
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Typical site of service: Ambulatory surgical center or hospital outpatient setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a child under 12 years old presenting with recurrent adenoid-related symptoms after a prior adenoidectomy. Common clinical presentations include persistent nasal obstruction, recurrent otitis media with effusion, sleep-disordered breathing or obstructive sleep apnea symptoms, and recurrent sinonasal infections. The workflow begins with an otolaryngology evaluation including history and physical exam, nasal endoscopy if tolerated, and review of prior operative reports confirming previous adenoidectomy. Audiology assessment and tympanometry are often obtained if middle ear disease or effusion is present. Imaging is rarely required. If recurrent hypertrophic or residual adenoid tissue is identified and conservative management has failed, the surgeon schedules a recurrent (secondary) adenoidectomy under general anesthesia in an ambulatory surgery center or hospital operating room. Preoperative documentation includes indication, prior surgical history, informed consent, airway assessment, and relevant comorbidities. Intraoperative documentation details anesthesia type, operative findings, technique (endoscopic or curette), hemostasis, any concurrent procedures (for example, myringotomy with tube placement), estimated blood loss, and complications. Postoperative notes include recovery, discharge criteria, and follow-up for symptom resolution and hearing assessment if indicated. Payors commonly involved include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare depending on coverage and patient age.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |