Needle Aspiration of Peritonsillar Abscess: Choosing the Correct CPT Code

Question:

Can you explain Peritonsillar Abscess billing 42700 vs 10160? Can we bill and defend 42700 if a provider does an FNA to evacuate a PTA?

Answer:

When a provider performs fine needle aspiration (FNA) to evacuate a peritonsillar abscess (PTA), the correct CPT code to report depends on the intent and technique of the procedure.

If it is truly a FNA and performed for diagnostic purposes, such as collecting a specimen for cytology or pathology, then CPT 10021 (Fine needle aspiration biopsy, without imaging guidance; first lesion) is appropriate.

If the provider uses a needle to evacuate pus from a peritonsillar abscess then this is considered a therapeutic aspiration, and CPT 10160 (Puncture aspiration of abscess, hematoma, bulla, or cyst) is the correct code.

According to CPT Assistant, February 2008, Volume 18, Issue 2, pages 8–9: "From a CPT coding perspective, an incision must be performed in order for an incision and drainage procedure to be reported; an aspiration procedure does not involve an incision.”

Therefore, CPT 42700, which describes incision and drainage of abscess; peritonsillar, is not appropriate unless an actual incision is made into the PTA. 

*This response is based on the best information available as of 10/23/25.