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nose surgery help??

Annette Posted Mon 19th of April, 2010 01:44:54 AM

Can I please get your opinions on the following report,

DX is posttraumatic nasal deformity with septal deviation, obstructive breathing, and bilateral turbinate hypertrophy. patient had bilateral inferior turbinectomy and septoplasty with subucous resection and cartilage graft to septum

The patient after was done had Neo Synephrine used to anesthetize the nasal membranes and then first the inferior turbinates bilaterally, electrosurgically cauterized, desiccated and the overhanging nasal bone removed. this opened the airway considerably, still the septal deformity required correction First the nasal spur, the nasal base was removed after raising the mucoperichondrium with a transmembranous incision and this was done using a rongeur. Upon removal of the nasal spur the patient had mucoperichondrial flaps were raised bilaterally posterior to zone III. The more severe deviation was removed and the patient then had the septum back in midline. Unilateral osteotomy was necessary to move the left nasal bone, which was deflected into the right airway and general pressure moved the nose into midline. Part of the resected submucous tissue was then used. The cartilage was secured under the distal septum as a step with multiple sutures of 4-0 vicryl. this was further reinforced the straightening of the septum. The patient at this point had a slight rasping of the direct nasal dorsum of the external cartilage was removed and then the skin was redraped. the internal nasal incision was closed with 5=0 chromic and the patient had xeroform gauze placed in nasal dorsum and plaster cast placed for unusual swelling.

Im thinking 30520 & 30130, 470, 478.0 E813.0? thank you

SuperCoder Answered Mon 19th of April, 2010 14:25:12 PM

As per this Op report, apart from septoplasty the physician is also performing an unilateral osteotomy which indicates that a rhinoplasty has been performed so in this case I would go with the CPT code 30420 and 738.0, 470.....

SuperCoder Answered Mon 19th of April, 2010 14:53:09 PM

Regarding the CPT codes, I agree with Betsy that 30520 and 30130 can be coded. As far as the Dx codes are concerned, 470, 478.0, 738.0 can be coded. Can't comment on E813.0, as we do not have the nature of the accident mentioned in the question.

Annette Posted Mon 19th of April, 2010 16:20:06 PM

If I use 30520 & 30130 Im confused about the nasal rasping he did & external cartilage being removed, doesn't this indicate something more than just work on the septum?

SuperCoder Answered Tue 20th of April, 2010 09:23:07 AM

The physician is performing a nasal rasping, a external cartilage removal and a lateral osteotomy which does not qualifies completely for the code 30520. Some extra bony work has also been performed in this case so i could land up with 30410. Final codes are 30410 and 30520.

Annette Posted Tue 20th of April, 2010 14:45:40 PM

no coding for excision of turbinates?

Annette Posted Tue 20th of April, 2010 14:55:51 PM

I was also thinking, why can't I use 30520 for septoplasty and 30400 for the nasal rasping/external cartilage procedure & 30130 excision of turbinates?

SuperCoder Answered Wed 21st of April, 2010 06:20:46 AM

As I said earlier that, you can also use the CPT code 30520 for septoplasty. But for rhinoplasty, I could go with the code 30410 because apart from nasal rasping/external cartilage a lateral osteotomy was also performed, so this code covers the lateral osteotomy. Excision of tubinates gets bundle with CPT code 30410, so it is not coded seperately.

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