CPT® Code 42836

1. Indications

The procedure of secondary adenoidectomy, coded as CPT® Code 42836, is indicated for patients aged 12 years or older who exhibit specific symptoms or conditions related to the adenoid tissue. These indications may include:

• Residual Adenoid Tissue The presence of leftover adenoid tissue following a previous adenoidectomy that continues to cause obstructive symptoms.
• Adenoid Regrowth The regrowth of adenoid tissue after an initial adenoidectomy, leading to similar symptoms as before.
• Obstructive Sleep Apnea Symptoms of obstructive sleep apnea that may be exacerbated by enlarged adenoids.
• Chronic Nasal Obstruction Persistent nasal blockage that affects breathing and quality of life.
• Recurrent Otitis Media Frequent ear infections that may be associated with adenoid hypertrophy.

2. Procedure

The secondary adenoidectomy procedure involves several critical steps to ensure the effective removal of adenoid tissue. The steps are as follows:

• Step 1: Anesthesia and Positioning The patient is placed under appropriate anesthesia, and the surgical team positions the patient to provide optimal access to the nasopharynx. A mouth prop is utilized to keep the mouth open and facilitate the procedure.
• Step 2: Retraction of the Soft Palate The physician carefully retracts the soft palate to expose the adenoid tissue located in the nasopharynx. This step is crucial for visualizing the surgical site and ensuring that the adenoids can be accessed effectively.
• Step 3: Selection of Instrument An appropriately sized adenoid curette, adenotome, or microdebrider is selected based on the specific needs of the procedure. The choice of instrument may depend on the extent of tissue removal required and the surgeon's preference.
• Step 4: Resection of Adenoid Tissue The selected instrument is positioned at the posterior edge of the vomer and pushed along the vault of the nasopharynx, carefully maneuvering over the odontoid process. The physician meticulously removes the adenoid tissue, ensuring that all remnants are excised.
• Step 5: Inspection and Removal of Remnants After the initial resection, the surgical site is inspected for any remaining adenoid tissue. If any remnants are identified, they are removed using a small curette or electrocautery to ensure complete excision.
• Step 6: Hemostasis Bleeding is controlled through the use of cautery and/or gauze sponges soaked in epinephrine, which helps to minimize blood loss during the procedure.

3. Post-Procedure

Following the secondary adenoidectomy, patients are typically monitored for any immediate complications. Post-procedure care may include pain management, instructions for dietary modifications, and guidelines for activity restrictions to promote healing. Patients may experience some discomfort, swelling, or mild bleeding, which is generally manageable. Follow-up appointments are essential to assess recovery and ensure that any residual symptoms are addressed. The expected recovery time may vary, but most patients can return to normal activities within a week, depending on individual healing and any additional factors related to their health status.