Tonsillectomy (child under 12)

What it is

The tonsils are two pads of lymph tissue at the back of the throat, one on each side. In children they are proportionally large, and they can be large enough to narrow the airway. A tonsillectomy removes them entirely, working through the open mouth — there is no external incision and no scar. The surgeon cuts or burns the tissue away and the raw areas are left to heal on their own rather than being stitched. This code is the version performed in a patient under twelve; the same operation in an older patient is coded separately, because the anesthesia, the recovery and the typical reasons differ. In young children the adenoids, a similar pad of tissue higher up behind the nose, are frequently removed during the same anesthetic.

Why it is done

• To open the airway in a child whose enlarged tonsils are causing snoring, restless sleep, or pauses in breathing at night
• To stop a cycle of throat infections that keep returning despite antibiotics and are costing the child school days
• To deal with an abscess beside the tonsil, or with tonsils that trap debris and keep becoming inflamed
• To remove a growth or an asymmetric tonsil that needs to be examined

What to expect

The child has nothing to eat or drink for some hours beforehand, is given general anesthesia, and is usually discharged the same day once awake and drinking. Some children — particularly the youngest, and those with significant sleep apnea — are kept overnight for monitoring instead. Afterwards the throat hurts for one to two weeks, and the pain often gets worse around days five to seven before it improves. Ear pain is common and comes from the throat, not the ear. Clinicians put more emphasis on fluids than on food. Bleeding is the complication families are told to watch for, because it can appear a week or more after the surgery.

Questions worth asking

• Are the adenoids being removed at the same time? That is a separate charge even though it is one anesthetic and one recovery.
• Is my child expected to go home the same day or stay overnight for observation? An overnight stay can turn an outpatient bill into an admission.
• Who provides the pediatric anesthesia, and is that group contracted with my plan? Anesthesia is billed separately from the surgeon.
• If a sleep study was required before approval, is it covered, and has the plan's authorization already been obtained?