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42835

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🩺 What 42835 Represents — Deep Clinical and Coding Detail

42835 describes a secondary (revision) adenoidectomy, performed when a patient who previously underwent adenoidectomy develops recurrent or persistent adenoidal tissue that again causes symptoms.
This is not a simple repeat of the primary procedure — it is coded separately because revision surgery is more technically complex, often requiring enhanced visualization, more precise dissection, and management of scar tissue.

Why revision adenoidectomy is needed

Adenoidal regrowth occurs in a small percentage of patients after primary adenoidectomy^1^.
Reasons include:

  • Incomplete removal during the first surgery
  • Lymphoid tissue regrowth, especially in younger children
  • Persistent infection or inflammation stimulating hypertrophy
  • Anatomical challenges (e.g., tissue near the torus tubarius or choanae)

Revision surgery is indicated when the regrown tissue causes:

  • Nasal obstruction
  • Snoring or sleep-disordered breathing
  • Persistent or recurrent otitis media
  • Eustachian tube dysfunction
  • Chronic nasal drainage
  • Hyponasal speech
  • Recurrent adenoiditis

How revision adenoidectomy differs from primary

Revision procedures often require:

  • Endoscopic visualization to identify residual tissue
  • Microdebrider techniques for precision
  • Cautery to manage scar tissue and bleeding
  • Targeted removal near the Eustachian tube openings
  • More careful dissection due to altered anatomy

This increased complexity is why 42835 exists as a separate CPT code.

🟦 ICD‑10‑CM Pairings (with HCC Status)

Most common medically necessary diagnosis

  • J35.2 — Hypertrophy of adenoids
    • Not an HCC

Other valid diagnoses

  • J35.3 — Hypertrophy of tonsils with hypertrophy of adenoids
  • J35.8 — Other chronic diseases of tonsils and adenoids
  • J35.9 — Unspecified chronic disease of tonsils and adenoids
  • G47.33 — Obstructive sleep apnea
  • H65.3X — Chronic serous otitis media
  • H66.90 — Otitis media, unspecified

HCC Summary

None of the typical diagnoses for revision adenoidectomy map to CMS HCC categories.

🟦 Global Surgical Package

  • Global period: 90 days
  • Includes:
    • Pre-op visit (day before/day of surgery)
    • Procedure
    • Routine post-op care
  • Excludes:
    • Return to OR for complications → modifier ‑78
    • Unrelated E/M during global → modifier ‑24
    • Distinct procedural services → ‑59 or X‑modifiers

🟦 Assistant Surgeon Status

  • Assistant surgeon allowed: Yes
  • Common modifiers:

🟦 wRVU Information

Work RVUs vary by year and locality.
Check the CMS Physician Fee Schedule for:

  • wRVU
  • Facility vs. non‑facility RVUs
  • Status indicators

🟦 Includes / Excludes

Includes

  • Secondary/revision adenoidectomy
  • Removal of regrown or residual adenoidal tissue
  • Endoscopic-assisted revision procedures
  • Procedures addressing persistent nasopharyngeal obstruction after prior surgery

Excludes

🟦 MS‑DRG Information

Revision adenoidectomy is usually outpatient.
If inpatient, DRG assignment depends on:

  • Principal diagnosis
  • Presence of CC/MCC
  • Age and comorbidities

Common DRG families may include:

  • Pediatric respiratory DRGs
  • ENT infection DRGs
  • Airway obstruction DRGs

🟦 Code Tree (Conceptual)

Surgery
 └── Digestive System
      └── Pharynx
           ├── Tonsillectomy (42820-42826)
           ├── Adenoidectomy (42830-42836)
           │     ├── 42830 - Primary adenoidectomy
           │     ├── 42831 - Primary adenoidectomy (age-specific)
           │     ├── 42835 - Secondary/revision adenoidectomy
           │     └── 42836 - Secondary/revision adenoidectomy (age-specific)
           └── Combined tonsil/adenoid procedures

🟦 Coding Examples

Example 1 — Recurrent Adenoidal Hypertrophy

  • CPT: 42835
  • Dx: J35.2
  • Indication: Regrowth causing nasal obstruction

Example 2 — Persistent Otitis Media After Prior Adenoidectomy

  • CPT: 42835
  • Dx: H65.33
  • Notes: Eustachian tube dysfunction persists despite prior surgery

Example 3 — Revision for Persistent Pediatric OSA

Example 4 — Assistant Surgeon

Example 5 — Return to OR for Postoperative Hemorrhage

🟦 Documentation Requirements

  • Document prior adenoidectomy (date if known)
  • Describe persistent or recurrent symptoms
  • Identify obstructive or hypertrophic residual tissue
  • Describe surgical technique used for revision
  • Document medical necessity for repeat surgery
  • Include findings such as:
    • Tissue regrowth
    • Scarring
    • Obstruction of choanae
    • Eustachian tube involvement

📚 Sources

  1. AAPC CPT 42835 summary (secondary adenoidectomy, under age 12).
  2. MD Clarity CPT 42835 overview, including modifier applicability and clinical context.

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