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Tonsillectomy in Children

In our continuing effort to promote clinical quality through adherence to evidence based clinical guidelines, we have implemented a new clinical guideline, CG-SURG-30. 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.  
Evidence demonstrates the tendency for most children to improve medically over time to the point where a significant proportion does not meet indications for tonsillectomy. Given the potential for surgical complications, it is important for parents and caregivers to be educated on the limited benefits of tonsillectomy when performed in less severely affected children. The primary purpose of this guideline is to provide clinicians with evidence-based guidance in identifying children who are the best candidates for tonsillectomy. 
Tonsillectomy Clinical Data Submission Tool that expedites the medical necessity review process. 
Throat Infection Episode Tracker for the pediatrician’s patient chart to facilitate ongoing documentation. 
PCP Referral Checklist for transfer of summary information from the PCP/pediatrician to the ENT specialist. 
Tonsillectomy and My Child a parent educational flyer to post in your office. 
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