Tonsils, Adenoids, and Ear Tubes: Age-Based ENT Coding
Tonsillectomy, adenoidectomy, and tympanostomy are high-volume procedures with codes driven by two variables: the patient's age and exactly what was done.
Tonsils and adenoids split at age 12
- 42820 / 42821 — tonsillectomy and adenoidectomy, under 12 / age 12+
- 42825 / 42826 — tonsillectomy only, under 12 / age 12+
- 42830–42836 — adenoidectomy only, by age and primary vs. secondary
Choose the combined T&A code when both were removed — don't report tonsillectomy and adenoidectomy separately.
Ear tubes: setting matters
Tympanostomy is 69433 under local anesthesia versus 69436 under general anesthesia (the usual pediatric OR case). Append -50 for the typical bilateral procedure.
What bundles
Diagnostic otoscopy/microscopy and cerumen removal at the same session are included. ICD-10 should reflect chronic tonsillitis/adenoid hypertrophy or recurrent otitis media with effusion at full specificity.
Clinical Capture applies the age band and the structures-removed logic automatically, and adds bilateral modifiers where the note supports them.
This article is educational and not coding, billing, or legal advice. Always verify codes and values against the current CPT®, ICD-10-CM, and CMS Physician Fee Schedule, follow NCCI edits and payer policy, and confirm with a certified coder before submitting a claim. Document only work that was actually performed.