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Tonsillectomy and adenoidectomy together: 42820 (under age 12) or 42821 (age 12 and over). Tonsillectomy primary alone: 42825 (<12) or 42826 (12+). Adenoidectomy primary alone: 42830 (<12) or 42831 (12+). Adenoidectomy SECONDARY (after previous removal): 42835/42836. Age categorization is critical for correct code selection.

Many FESS endoscopic procedures have NCCI edits — for example, 31255 (ethmoidectomy total) bundles 31254 (partial) on the same side. Diagnostic nasal endoscopy 31231 is bundled when therapeutic procedure performed in same area. Bilateral procedures use modifier 50 (most sinus codes are NOT inherently bilateral — check parenthetical descriptors). Septoplasty 30520 is often performed concurrently and is separately billable when done for septal pathology, not just access.

69209 = cerumen removal with irrigation/lavage; 69210 = with instrumentation. Medicare requires medical necessity documentation (impacted cerumen, hearing loss). For Medicare patients, billing both 69209 and 69210 same encounter is generally not allowed — choose the more extensive method. Bilateral cerumen removal: append modifier 50. ABN required if performed routinely without medical necessity (modifier GA).