2025 CPT code 42975
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Pharynx, Adenoids, and Tonsils Surgery Feed
Drug-induced sleep endoscopy, with dynamic evaluation of velum, pharynx, tongue base, and larynx for evaluation of sleep-disordered breathing, flexible, diagnostic.
Modifiers such as 22 (Increased Procedural Services), 52 (Reduced Services), 53 (Discontinued Procedure), and others may be applicable depending on the circumstances of the procedure.
Medical necessity for 42975 is established when the patient presents with signs and symptoms of sleep-disordered breathing, such as snoring, witnessed apneas, excessive daytime sleepiness, or other related symptoms, and the information obtained from DISE is necessary to guide treatment decisions.
The physician is responsible for administering sedation, performing the endoscopy, evaluating the airway, and determining the best treatment strategy for the patient's sleep-disordered breathing based on the findings.
In simple words: While the patient is asleep under sedation, a doctor uses a small, flexible tube with a camera and light (an endoscope) to look into their throat and check the palate and tongue areas. This helps the doctor see where breathing is blocked during sleep, especially in people with sleep apnea. This information is used to plan the best treatment for the patient's sleep-disordered breathing.
This procedure involves a flexible, diagnostic endoscopy performed under drug-induced sleep. It focuses on the dynamic evaluation of the velum, pharynx, tongue base, and larynx to assess sleep-disordered breathing.The patient is sedated and asleep while the provider inserts a flexible endoscope into the airway, often through the nose.Observations are made of the areas mentioned above to pinpoint the location of airway obstruction as the patient experiences breathing difficulties during sleep.This helps determine the most effective treatment approach for conditions like obstructive sleep apnea (OSA).
Example 1: A patient with suspected obstructive sleep apnea undergoes drug-induced sleep endoscopy to assess the location and severity of airway obstruction during sleep., A patient with persistent snoring despite conservative treatment undergoes DISE to determine the cause of the snoring and guide treatment decisions., A patient with complex sleep-disordered breathing, involving multiple levels of obstruction, undergoes DISE to evaluate the dynamic interactions of the airway structures during sleep.
Documentation should include details about the patient's sleep disorder symptoms, the administration of sedation, the insertion and navigation of the endoscope, the dynamic observations of the velum, pharynx, tongue base, and larynx during simulated sleep, and the assessment of airway obstruction.The medical necessity for the procedure, related diagnoses, and treatment plan should also be documented.
- Specialties:Otolaryngology, Sleep Medicine, Pulmonology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient Department, Office