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The procedure described by CPT® Code 42806 involves a biopsy of the nasopharynx, which is the upper section of the pharynx that connects to the nasal passages. This specific biopsy is conducted as a survey for an unknown primary lesion, meaning it is performed when there is an abnormal growth or lesion present in the nasopharynx, but the origin of this lesion is not known. Unlike a simple biopsy, which targets a visible lesion as described in CPT® Code 42804, the biopsy under code 42806 necessitates obtaining a larger tissue sample. This larger sample is crucial for accurately identifying the source of the lesion and for classifying the type of neoplasm present. The procedure typically requires the administration of a general anesthetic to ensure patient comfort and safety during the biopsy process.
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The biopsy of the nasopharynx, as indicated by CPT® Code 42806, is performed under specific circumstances where there is a need to investigate an abnormal growth or lesion. The following conditions may warrant this procedure:
The procedure for conducting a biopsy of the nasopharynx as per CPT® Code 42806 involves several critical steps to ensure accurate sampling and diagnosis. The following procedural steps are typically followed:
Following the biopsy procedure, patients are typically monitored in a recovery area until the effects of the general anesthesia wear off. Post-procedure care may include instructions on managing any discomfort, potential bleeding, or signs of infection at the biopsy site. Patients are advised to follow up with their healthcare provider to discuss the results of the biopsy and any further necessary treatment based on the findings. It is important for patients to adhere to any specific post-operative instructions provided by their healthcare team to ensure proper healing and recovery.
| Short Descr | BIOPSY OF UPPER NOSE/THROAT | Medium Descr | BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION | Long Descr | Biopsy; nasopharynx, survey for unknown primary lesion | 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) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 31 - Diagnostic 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). | 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. | 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.) | 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 | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | 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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| Pre-1990 | Added | Code added. |
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