Wiki Excision of tracheal granulomas

AN2114

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The doctor did a direct laryngoscopy and bronchoscopy, excision of tracheal granulomas, and balloon dilation. The code I have for the balloon dilation is 31630. I'm having a hard time finding a code for the excision o the tracheal granulomas. Would it be included in the 31630 code? I also found code 31640 but wasn't sure if that code would be appropriate. Any advice?? Below is the op report

Postop Diagnosis: status post trach, status post laryngotracheal reconstruction, subglottic stenosis

Procedure: Direct laryngscopy and bronchoscopy, excision of tracheal granulomas, balloon dilation

Details:
Patient brought to OR. Timeout was called indicating correct patient and procedure. Anesthesia was induced. The patient was prepped and draped in a sterile fashion. Using a Phillips laryngoscope and hopkins rod the supraglottic structures we evaluated. Using the hopkins rod the glottic introitus was entered. There was hypertrophy of the right false vocal fold. The immediate subglottis showed some mild stenosis, grade 1 but markedly improved. The proximal trachea had granulation tissue above the trachestomy tube site and at the stoma site. The tracheostomy tube was temporarily pulled out to advance the hopkins rod. The distal trachea was normal. No blunting of the carina was observed. The right and left mainstem bronchi were without abnormality. No foreign bodies were observed.

Next, using a cupped forceps and the hopkins rod the superior granulation tissue was removed entirely. Next, using a cupped forceps and the hopkins rod the superior granulation tissue was removed entirely. Next, again with the cupped forceps the granulation tissue was grasped and removed entirely.. The tracheostomy tube was visualized.

A dedo laryngoscope was inserted and then suspended. The rigid bronch along with a size 7 accalarant tracheal dilation balloon was then inserted to the level of the obstruction. The balloon was inflated to 12 mmHg and held for 2 minutes. Balloon and scope were removed with marked improvement. Patient was handed back over to anesthesia for wakeup. Mouth guard removed.
 
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