bvansickle
New
- Messages
- 3
- Location
- Hudson, FL
Looking for input from anyone coding ENT cases using the biodesign butterfly graft.
op note A - Once adequate anesthesia was achieved the table was turned 90 degrees and microscope was brought into. Otomicroscopy was performed noting mild debris in the ear canal with mucosal elation near the tympanic membrane. The perforation was noted however to be dry and with no evidence of infection within the middle ear or at the tympanic membrane site therefore it was decided to proceed with bio design type graft for repair. He was then prepped and draped in usual sterile fashion. Microscope was brought in, speculum was placed, ear was irrigated with saline. the perforation was then edged with sharp Rosen pick removing all squamous epithelium. the malleus was exposed with limited squamous epithelium noted at the long end. perforation was measured and initially a 4mm bio design graft was attempted to be placed however it was too small. 6mm was then used and adequately positioned using a Rosen pick with the disc deep into the perforation in the cross design above this part of which extended onto the mucosalized portion of the ear canal. dry gel foam was then packed over this with small amounts of ciprofloxacin soaked gelfoam. antibiotic ointment was then placed into the remainder of the ear canal and a cotton ball and then Velcro mastoid dressing were placed.
op note B - The patient was prepped and draped in the standard surgical fashion under surgical microscope. The tympanic membrane of the left ear was visualized. There was a circular perforation that was 3.5 MM in diameter in the anterior inferior quadrant. The edges of the preparation were roughened, and the epithelial rim was removed. The ossicular chain appeared to have normal mobility. The 4 mm bio design butterfly graft was opened on the field. it was moistened with saline. using alligator forceps the disc portion of the graft was placed on the perforation. It was deployed in an underlay fashion with gentle pressure using a Rosen needle. The graft was gently rotated to maximize contact with the Disc. The phalanges were adjusted to improve adherence. Gelfoam was placed along the graph site. ointment and cotton ball were placed in the ear canal. the patient was awakened and taken to the PACU in satisfactory condition.
Looking for feedback on 69610 or 69620 as no tympanomeatal flap is being elevated. Feedback from ASC who supplies the graft wants CPT 69610 and 15770 prior authorized with insurance carrier.
op note A - Once adequate anesthesia was achieved the table was turned 90 degrees and microscope was brought into. Otomicroscopy was performed noting mild debris in the ear canal with mucosal elation near the tympanic membrane. The perforation was noted however to be dry and with no evidence of infection within the middle ear or at the tympanic membrane site therefore it was decided to proceed with bio design type graft for repair. He was then prepped and draped in usual sterile fashion. Microscope was brought in, speculum was placed, ear was irrigated with saline. the perforation was then edged with sharp Rosen pick removing all squamous epithelium. the malleus was exposed with limited squamous epithelium noted at the long end. perforation was measured and initially a 4mm bio design graft was attempted to be placed however it was too small. 6mm was then used and adequately positioned using a Rosen pick with the disc deep into the perforation in the cross design above this part of which extended onto the mucosalized portion of the ear canal. dry gel foam was then packed over this with small amounts of ciprofloxacin soaked gelfoam. antibiotic ointment was then placed into the remainder of the ear canal and a cotton ball and then Velcro mastoid dressing were placed.
op note B - The patient was prepped and draped in the standard surgical fashion under surgical microscope. The tympanic membrane of the left ear was visualized. There was a circular perforation that was 3.5 MM in diameter in the anterior inferior quadrant. The edges of the preparation were roughened, and the epithelial rim was removed. The ossicular chain appeared to have normal mobility. The 4 mm bio design butterfly graft was opened on the field. it was moistened with saline. using alligator forceps the disc portion of the graft was placed on the perforation. It was deployed in an underlay fashion with gentle pressure using a Rosen needle. The graft was gently rotated to maximize contact with the Disc. The phalanges were adjusted to improve adherence. Gelfoam was placed along the graph site. ointment and cotton ball were placed in the ear canal. the patient was awakened and taken to the PACU in satisfactory condition.
Looking for feedback on 69610 or 69620 as no tympanomeatal flap is being elevated. Feedback from ASC who supplies the graft wants CPT 69610 and 15770 prior authorized with insurance carrier.