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New tonsillectomy guidelines for patients under 18 years of age

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In our continuing effort to promote clinical quality through adherence to evidence based clinical guidelines, Empire BlueCross BlueShield is implementing a new clinical guideline, CG-SURG-30 effective July 14, 2012.  
Our Medical Policy & Technology Assessment Committee concurs with the recommendations by the American Academy of Otolaryngology Head and Neck Surgery’s Clinical Practice Guideline: “Tonsillectomy in Children”. The guideline advocates watchful waiting for recurrent throat infection in most patients, and reserves surgical tonsillectomy for patients with severe disease. The guideline also emphasizes the importance of appropriate documentation of throat infections to prevent potential overstatement of caregivers, or the tendency for recurrences to naturally diminish over time.  
The following tools are available in a tonsillectomy provider toolkit
Tonsillectomy Clinical Data Submission Tool that expedites the medical necessity review process.
Throat Infection Episode Tracker for the pediatrician’s patient chart to facilitate documentation.
PCP Referral Checklist for transfer of summary information from the PCP/pediatrician to the ENT specialist.
A parent educational flyer for your office.
 
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