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CPT 42962: Postoperative Oral and Pharyngeal Hemostasis

CPT code 42962 denotes a surgical procedure to control bleeding in the mouth and pharynx after procedures such as tonsillectomy, performed as an urgent primary intervention within 24 hours or as a secondary procedure up to two weeks postoperatively. Nationally, this code captures acute postoperative airway and bleeding management events that have implications for hospital resource use, surgical follow-up, and quality reporting. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find: a clear clinical context for when CPT code 42962 is reported; the typical sites of service where the procedure is performed; common billing modifiers associated with perioperative and emergent surgical services; and discussion of payer coverage patterns and claims considerations where available. The summary highlights how the code is used to document interventions for postoperative hemorrhage in the oral cavity and pharynx, and outlines what to expect in claims workflows and policy reviews. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 42962 describes a surgical procedure to control hemorrhage in the oral cavity and pharynx occurring within 24 hours (primary) or up to two weeks (secondary) after operations such as tonsillectomy. The procedure involves direct surgical means to achieve hemostasis in the mouth and throat following postoperative bleeding.

Service type: Surgical hemostasis procedure
Typical site of service: Operative suite or ambulatory surgical center; may also occur in hospital inpatient or emergency department settings depending on timing and clinical urgency.

Data not available in the input.

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CPT 42962: Postoperative Oral and Pharyngeal Hemostasis

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Billing Code Overview

Service type: Surgical hemostasis procedure
Typical site of service: Operative suite or ambulatory surgical center; may also occur in hospital inpatient or emergency department settings depending on timing and clinical urgency.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a child or adult who returns to the emergency department or ambulatory surgical center with postoperative hemorrhage following a tonsillectomy or related oropharyngeal procedure. The patient presents within 24 hours (primary) or up to two weeks (secondary) after the original surgery with active bleeding from the tonsillar beds, oropharynx, or posterior pharynx, accompanied by visible blood in the mouth, hematemesis, or hemodynamic instability. Initial triage includes airway assessment, vital signs, IV access, fluid resuscitation, and laboratory studies (complete blood count, coagulation panel, type and screen). If bleeding persists or is brisk, the otolaryngology surgeon performs a focused operative procedure in the operating room or procedure suite to identify and control the bleeding source using surgical techniques such as cauterization, suture ligation, topical agents, or electrocautery. The procedure often requires general anesthesia, suctioning of blood and clots, and documentation of the timing relative to the index tonsillectomy (primary within 24 hours or secondary up to 14 days). Postoperative care includes airway monitoring, observation for recurrent bleeding, pain control, and communication with the surgical and anesthesia teams and the patient’s payer for authorization and billing documentation.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure required substantially greater effort or complexity than usual (extensive bleeding control, prolonged operative time).
`23`	Unusual anesthesia	Use when general anesthesia is required for a procedure that normally may be done with local or no anesthesia.
`24`	Unrelated evaluation and management service by the same physician during a postoperative period	Use for E/M visits unrelated to the postoperative course during the global period.
`26`	Professional component	Use if separate billing is needed for the physician’s interpretation or professional portion of a service.
`50`	Bilateral procedure	Use if bilateral control procedures are reported and payer requires modifier for bilateral work.
`52`	Reduced services	Use when the procedure was started but not completed or was curtailed.
`53`	Discontinued procedure	Use when the procedure was terminated due to extenuating circumstances.
`59`	Distinct procedural service	Use when a separate, distinct procedure not normally reported together is performed on the same date.
`76`	Repeat procedure by same physician	Use if the same physician repeats the procedure later the same day.
`78`	Return to the operating room for a related procedure during the postoperative period	Use when the patient returns to the OR for bleeding control related to the original surgery.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when a different, unrelated procedure is performed during the global period.
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons.
`66`	Surgical team	Use when a surgical team approach is documented.
`QK`	Medical direction of certified registered nurse anesthetist (CRNA)	Use when physician directs multiple CRNAs for anesthesia services.

Taxonomy Code	Specialty	Notes
207L00000X	Otolaryngology	Primary specialty performing tonsillar hemorrhage control procedures.
207K00000X	Otolaryngology - Pediatric	Pediatric-focused surgeons for tonsillectomy complications in children.
208D00000X	General Surgery	General surgeons may manage severe oropharyngeal bleeding in some settings.
207T00000X	Neurotology	May be involved for complex head and neck bleeding cases (less common).
363A00000X	Anesthesiology	Provides anesthesia management for operative control of bleeding.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J35.3`	Hypertrophy of tonsils and adenoids	Common indication for tonsillectomy; postoperative bleeding can occur after this index surgery.
`J03.90`	Acute tonsillitis, unspecified	Infection leading to tonsillectomy or complicating postoperative healing with potential bleeding.
`K92.2`	Gastrointestinal hemorrhage, unspecified	May be used for documented hematemesis when source is oropharyngeal bleeding presenting as GI bleeding symptom.
`R04.0`	Epistaxis	Differentiates nasal bleeding from oropharyngeal sources when both nasal and oropharyngeal bleeding are considered.
`T81.0XXA`	Hemorrhage and hematoma complicating a procedure, initial encounter	Used to indicate postoperative hemorrhage related to the surgical procedure.
`Z48.02`	Encounter for removal of sutures and staples	Relevant when return to OR requires removal or revision of prior surgical site closures.
`Z98.890`	Other specified postprocedural states	Captures postoperative status when coding for complications of prior head and neck surgery.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`42826`	Tonsillectomy and adenoidectomy; younger than 12 years, with or without cautery	Often the index procedure after which postoperative hemorrhage requiring `42962` can occur.
`42820`	Tonsillectomy, primary; younger than 12 years, without adenoidectomy	An index surgery commonly preceding postoperative bleeding events addressed by `42962`.
`30901`	Excision of tonsillar tissue, peritonsillar abscess drainage	Performed for related oropharyngeal infections that may complicate bleeding control or present in the differential.
`99284`	Emergency department visit, moderate to high severity	Common E/M code for ED evaluation preceding the operative control of bleeding.
`99100`	Anesthesia for emergency major surgery or trauma, not otherwise specified	May be used for anesthesia billing when emergent operative control of bleeding is performed.
`36415`	Collection of venous blood by venipuncture	Common ancillary service for preoperative labs during evaluation and stabilization prior to `42962`.

CPT 42955: Pharyngostomy for Long-Term Enteral Feeding

CPT-42960-OROPHARYNGEAL-BLEEDING-CONTROL-POSTOPERATIVE

CPT 42960: Control of Postoperative Oropharyngeal Bleeding

CPT-42961-OROPHARYNGEAL-POSTOPERATIVE-HEMORRHAGE-CONTROL-HOSPITAL

CPT 42961: Control of Postoperative Oropharyngeal Bleeding, Inpatient

CPT-42970-POSTOP-NASOPHARYNGEAL-BLEEDING-CONTROL

CPT 42970: Simple Control of Postoperative Nasopharyngeal Bleeding

CPT-42971-NASOPHARYNGEAL-BLEEDING-CONTROL-POST-ADENOIDECTOMY

CPT 42971: Inpatient Control of Postoperative Nasopharyngeal Bleeding

CPT-42972-NASOPHARYNGEAL-BLEEDING-CONTROL-POST-ADENOIDECTOMY

CPT 42972: Surgical Control of Postoperative Nasopharyngeal Bleeding

CPT-42975-ENDOSCOPIC-AIRWAY-EVALUATION-SLEEP-DISORDERED-BREATHING

CPT 42975: Endoscopic Airway Evaluation During Sedation

CPT-42999-UNLISTED-PHARYNX-ADENOIDS-TONSILS-PROCEDURE

CPT 42999: Unlisted Pharynx, Adenoids, or Tonsils Procedure

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure required substantially greater effort or complexity than usual (extensive bleeding control, prolonged operative time).
`23`	Unusual anesthesia	Use when general anesthesia is required for a procedure that normally may be done with local or no anesthesia.
`24`	Unrelated evaluation and management service by the same physician during a postoperative period	Use for E/M visits unrelated to the postoperative course during the global period.
`26`	Professional component	Use if separate billing is needed for the physician’s interpretation or professional portion of a service.
`50`	Bilateral procedure	Use if bilateral control procedures are reported and payer requires modifier for bilateral work.
`52`	Reduced services	Use when the procedure was started but not completed or was curtailed.
`53`	Discontinued procedure	Use when the procedure was terminated due to extenuating circumstances.
`59`	Distinct procedural service	Use when a separate, distinct procedure not normally reported together is performed on the same date.
`76`	Repeat procedure by same physician	Use if the same physician repeats the procedure later the same day.
`78`	Return to the operating room for a related procedure during the postoperative period	Use when the patient returns to the OR for bleeding control related to the original surgery.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when a different, unrelated procedure is performed during the global period.
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons.
`66`	Surgical team	Use when a surgical team approach is documented.
`QK`	Medical direction of certified registered nurse anesthetist (CRNA)	Use when physician directs multiple CRNAs for anesthesia services.

Taxonomy Code	Specialty	Notes
207L00000X	Otolaryngology	Primary specialty performing tonsillar hemorrhage control procedures.
207K00000X	Otolaryngology - Pediatric	Pediatric-focused surgeons for tonsillectomy complications in children.
208D00000X	General Surgery	General surgeons may manage severe oropharyngeal bleeding in some settings.
207T00000X	Neurotology	May be involved for complex head and neck bleeding cases (less common).
363A00000X	Anesthesiology	Provides anesthesia management for operative control of bleeding.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J35.3`	Hypertrophy of tonsils and adenoids	Common indication for tonsillectomy; postoperative bleeding can occur after this index surgery.
`J03.90`	Acute tonsillitis, unspecified	Infection leading to tonsillectomy or complicating postoperative healing with potential bleeding.
`K92.2`	Gastrointestinal hemorrhage, unspecified	May be used for documented hematemesis when source is oropharyngeal bleeding presenting as GI bleeding symptom.
`R04.0`	Epistaxis	Differentiates nasal bleeding from oropharyngeal sources when both nasal and oropharyngeal bleeding are considered.
`T81.0XXA`	Hemorrhage and hematoma complicating a procedure, initial encounter	Used to indicate postoperative hemorrhage related to the surgical procedure.
`Z48.02`	Encounter for removal of sutures and staples	Relevant when return to OR requires removal or revision of prior surgical site closures.
`Z98.890`	Other specified postprocedural states	Captures postoperative status when coding for complications of prior head and neck surgery.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`42826`	Tonsillectomy and adenoidectomy; younger than 12 years, with or without cautery	Often the index procedure after which postoperative hemorrhage requiring `42962` can occur.
`42820`	Tonsillectomy, primary; younger than 12 years, without adenoidectomy	An index surgery commonly preceding postoperative bleeding events addressed by `42962`.
`30901`	Excision of tonsillar tissue, peritonsillar abscess drainage	Performed for related oropharyngeal infections that may complicate bleeding control or present in the differential.
`99284`	Emergency department visit, moderate to high severity	Common E/M code for ED evaluation preceding the operative control of bleeding.
`99100`	Anesthesia for emergency major surgery or trauma, not otherwise specified	May be used for anesthesia billing when emergent operative control of bleeding is performed.
`36415`	Collection of venous blood by venipuncture	Common ancillary service for preoperative labs during evaluation and stabilization prior to `42962`.

CPT 42955: Pharyngostomy for Long-Term Enteral Feeding

CPT-42960-OROPHARYNGEAL-BLEEDING-CONTROL-POSTOPERATIVE

CPT 42960: Control of Postoperative Oropharyngeal Bleeding

CPT-42961-OROPHARYNGEAL-POSTOPERATIVE-HEMORRHAGE-CONTROL-HOSPITAL

CPT 42961: Control of Postoperative Oropharyngeal Bleeding, Inpatient

CPT-42970-POSTOP-NASOPHARYNGEAL-BLEEDING-CONTROL

CPT 42970: Simple Control of Postoperative Nasopharyngeal Bleeding

CPT-42971-NASOPHARYNGEAL-BLEEDING-CONTROL-POST-ADENOIDECTOMY

CPT 42971: Inpatient Control of Postoperative Nasopharyngeal Bleeding

CPT-42972-NASOPHARYNGEAL-BLEEDING-CONTROL-POST-ADENOIDECTOMY

CPT 42972: Surgical Control of Postoperative Nasopharyngeal Bleeding

CPT-42975-ENDOSCOPIC-AIRWAY-EVALUATION-SLEEP-DISORDERED-BREATHING

CPT 42975: Endoscopic Airway Evaluation During Sedation

CPT-42999-UNLISTED-PHARYNX-ADENOIDS-TONSILS-PROCEDURE

CPT 42999: Unlisted Pharynx, Adenoids, or Tonsils Procedure

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 42962: Postoperative Oral and Pharyngeal Hemostasis

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Billing Code Overview

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OpenPayer

CPT 42962: Postoperative Oral and Pharyngeal Hemostasis

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References