codedog
True Blue
one coder says they use 30140-50 while other says 30801 ,not sure who is right, only becuase it states middleturbinate not inferior .
Who would be right ?
STOPERATIVE DIAGNOSES: Hypertrophied nasal turbinates with the left being greater than the right with chronic bilateral maxillary sinusitis, chronic bilateral ethmoid sinusitis, chronic bilateral frontal sinusitis, adhesion of the right middle turbinate to the lateral nose, adhesion of the left middle turbinate to the lateral nose with closure of the maxillary ostium, bilateral anterior and posterior ethmoid polyps and bilateral frontal recess polyps with obstruction, large left middle turbinate.
OPERATION: Nasal turbinate cautery with bilateral maxillary antrostomy revision, bilateral ethmoid revision, bilateral frontal recess polypectomy using the image-guided system, turbinate reduction.
PROCEDURE IN DETAIL:
was given adequate preoperative sedation and brought to the operating room where he was placed in a supine position and placed under general endotracheal anesthesia. He was draped in the usual fashion for surgery of the nose and sinuses using the image-guided system. internal nose was examined with a telescope. had inferior turbinate hypertrophy with the left side being greater than the right causing nasal obstruction. There was a polypoid tissue coming from the upper middle meatus bilaterally and extending into the posterior choana area of the nose, particularly on the left side. There were adhesions of the middle turbinates to the lateral nasal wall causing obstruction from the ostium which was opened in a previous surgery. The nasal septum and middle turbinates were injected with approximately 3 cc of 1:60,000 solution of epinephrine and saline. Bovie and needle technique along with outfracture was utilized to reduce the inferior turbinates, which opened the nasal airway and afforded a view of the nasopharynx which was clear. The adhesions of the middle turbinates to the lateral nasal wall were transected beginning on the right side and the maxillary sinus natural ostium was identified and opened widely. Polypoid tissue was removed there. The ethmoid area had polypoid disease which was removed in the anterior ethmoid superiorly and in the posterior ethmoid as well.
There was polypoid tissue in the frontal recess which was removed until the frontal sinus was opened. On the left side, the same thing was encountered, an adhesion of the middle turbinate to the lateral nasal wall, which was lysed. The middle turbinate was retracted medially, and the maxillary natural ostium was opened by removing the polypoid debris and the anterior and posterior ethmoids cells had a very dense bone which was traversed manually and this allowed removal of polypoid tissue throughout the ethmoid. The frontal recess had polyps and they were removed opening the frontal sinus as well on the left side. During this portion of the procedure, the surgical navigation system was utilized. With this done, the procedure was terminated after a silastic wafer was placed lateral to the middle turbinate bilaterally. Some FloSeal was placed in the ethmoid sinus bilaterally to prevent oozing, and no packing was then required. He was awakened, extubated, and taken to the recovery room in good condition.
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Who would be right ?
STOPERATIVE DIAGNOSES: Hypertrophied nasal turbinates with the left being greater than the right with chronic bilateral maxillary sinusitis, chronic bilateral ethmoid sinusitis, chronic bilateral frontal sinusitis, adhesion of the right middle turbinate to the lateral nose, adhesion of the left middle turbinate to the lateral nose with closure of the maxillary ostium, bilateral anterior and posterior ethmoid polyps and bilateral frontal recess polyps with obstruction, large left middle turbinate.
OPERATION: Nasal turbinate cautery with bilateral maxillary antrostomy revision, bilateral ethmoid revision, bilateral frontal recess polypectomy using the image-guided system, turbinate reduction.
PROCEDURE IN DETAIL:
was given adequate preoperative sedation and brought to the operating room where he was placed in a supine position and placed under general endotracheal anesthesia. He was draped in the usual fashion for surgery of the nose and sinuses using the image-guided system. internal nose was examined with a telescope. had inferior turbinate hypertrophy with the left side being greater than the right causing nasal obstruction. There was a polypoid tissue coming from the upper middle meatus bilaterally and extending into the posterior choana area of the nose, particularly on the left side. There were adhesions of the middle turbinates to the lateral nasal wall causing obstruction from the ostium which was opened in a previous surgery. The nasal septum and middle turbinates were injected with approximately 3 cc of 1:60,000 solution of epinephrine and saline. Bovie and needle technique along with outfracture was utilized to reduce the inferior turbinates, which opened the nasal airway and afforded a view of the nasopharynx which was clear. The adhesions of the middle turbinates to the lateral nasal wall were transected beginning on the right side and the maxillary sinus natural ostium was identified and opened widely. Polypoid tissue was removed there. The ethmoid area had polypoid disease which was removed in the anterior ethmoid superiorly and in the posterior ethmoid as well.
There was polypoid tissue in the frontal recess which was removed until the frontal sinus was opened. On the left side, the same thing was encountered, an adhesion of the middle turbinate to the lateral nasal wall, which was lysed. The middle turbinate was retracted medially, and the maxillary natural ostium was opened by removing the polypoid debris and the anterior and posterior ethmoids cells had a very dense bone which was traversed manually and this allowed removal of polypoid tissue throughout the ethmoid. The frontal recess had polyps and they were removed opening the frontal sinus as well on the left side. During this portion of the procedure, the surgical navigation system was utilized. With this done, the procedure was terminated after a silastic wafer was placed lateral to the middle turbinate bilaterally. Some FloSeal was placed in the ethmoid sinus bilaterally to prevent oozing, and no packing was then required. He was awakened, extubated, and taken to the recovery room in good condition.
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