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The procedure described by CPT® Code 42000 involves the drainage of an abscess located in the palate or uvula. The palate, which constitutes the roof of the mouth, is divided into two distinct parts: the hard palate, which is bony and forms the anterior section, and the soft palate, which is muscular and forms the posterior section. The uvula, a small conical structure that hangs from the soft palate, is made up of connective tissue, racemose glands, and some muscular fibers. During this procedure, a thorough examination of the roof of the mouth is conducted to locate the abscess pocket, which may be situated in either the soft palate or the uvula. Once identified, the abscess is treated by either puncturing it with a needle to aspirate the pus or by making an incision to allow the pus to drain freely. In the latter case, suction may be employed to remove the pus from the throat, and the incision is intentionally left open to facilitate ongoing drainage. This procedure is essential for alleviating pain and preventing further complications associated with the abscess.
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The drainage of an abscess of the palate or uvula, as described by CPT® Code 42000, is indicated in the following situations:
The procedure for draining an abscess of the palate or uvula involves several key steps, which are outlined as follows:
Following the drainage of an abscess of the palate or uvula, patients may require specific post-procedure care. It is important to monitor the incision site for signs of infection or complications. Patients are typically advised to maintain good oral hygiene and may be prescribed pain management medications to alleviate discomfort. Additionally, follow-up appointments may be necessary to assess healing and ensure that the abscess does not recur. Patients should be educated on signs of complications, such as increased swelling, fever, or difficulty breathing, which would necessitate immediate medical attention.
| Short Descr | DRAINAGE MOUTH ROOF LESION | Medium Descr | DRAINAGE ABSCESS PALATE UVULA | Long Descr | Drainage of abscess of palate, uvula | Status Code | Active Code | Global Days | 010 - Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 32 - Other non-OR therapeutic procedures on nose, mouth and pharynx |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period |
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| Pre-1990 | Added | Code added. |
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