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The procedure described by CPT® Code 42804 involves a biopsy of the nasopharynx, specifically targeting a visible lesion. The nasopharynx is anatomically located at the upper part of the pharynx, which connects to the nasal passages. In this procedure, a simple biopsy is conducted, which entails the removal of one or more tissue samples from the identified lesion. Prior to the biopsy, a local anesthetic is administered to minimize discomfort for the patient during the procedure. The collected tissue samples are then sent for laboratory analysis, which is reported separately. This procedure is distinct from other biopsy codes, such as CPT® Code 42806, which involves a more extensive biopsy for cases where the primary lesion is unknown and typically requires a larger tissue sample and general anesthesia. The simplicity of the biopsy in CPT® Code 42804 is characterized by its focus on visible lesions and the use of local anesthesia, making it a less invasive option for diagnostic purposes.
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The procedure associated with CPT® Code 42804 is indicated for the evaluation of visible lesions located in the nasopharynx. The following conditions may warrant this biopsy:
The procedure for CPT® Code 42804 involves several key steps to ensure the effective collection of tissue samples from the nasopharynx. First, the patient is positioned appropriately to allow for optimal access to the nasopharynx. Next, a local anesthetic is administered to the area surrounding the visible lesion. This step is crucial as it helps to minimize any discomfort the patient may experience during the biopsy. Following the administration of the anesthetic, the physician uses a biopsy instrument to carefully excise one or more tissue samples from the visible lesion. The technique employed may vary depending on the size and location of the lesion, but the goal remains the same: to obtain sufficient tissue for diagnostic analysis. Once the samples are collected, they are placed in appropriate containers and sent to a laboratory for further examination. The results of this analysis will provide critical information regarding the nature of the lesion, aiding in diagnosis and subsequent treatment planning.
After the biopsy procedure is completed, the patient may be monitored briefly to ensure there are no immediate complications. Post-procedure care typically includes instructions on managing any discomfort, which may involve the use of over-the-counter pain relief medications. Patients are advised to avoid strenuous activities and to follow up with their healthcare provider to discuss the results of the biopsy once they are available. It is also important for patients to report any unusual symptoms, such as excessive bleeding or signs of infection, to their healthcare provider promptly. Overall, the recovery from a simple biopsy of the nasopharynx is generally quick, with most patients resuming normal activities shortly after the procedure.
| Short Descr | BIOPSY OF UPPER NOSE/THROAT | Medium Descr | BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE | Long Descr | Biopsy; nasopharynx, visible lesion, simple | 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) | 1 - Statutory 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 | Hospital Part B services paid through a comprehensive APC | 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) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 31 - Diagnostic procedures on nose, mouth and pharynx |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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