Blackhorse
Guru
DESCRIPTION OF PROCEDURE: The patient was explained the risks and benefits, and appropriate consent form signed. The patient was taken to the operating room and general anesthesia was induced. Nose and face were sterilely prepped and draped and Stryker navigation system was applied with standard registration protocol followed and accuracy verified with landmarks. Under endoscopic guidance,
The middle turbinate attachments were injected with local anesthetic. The right-sided procedure was first undertaken. The middle turbinate was compressed laterally and straight cutting forceps were used to remove the polyps arising from medial surface of the structure without traumatizing the cribrifonn. Now middle turbinate was replaced toward the midline and polyps were removed from the inferior portion of the middle turbinate. Now, the uncinate process was palpated and excised from the lateral nasal wall removing polyps arising from this structure. The maxillary sinus ostium was widened anteriorly and posteriorly using side-biting forceps and up-biting forceps and polyps were removed f r om the sinus itself. The ethmoid bulla was opened and polyps were removed back through the basal lamella of the middle turbinate. Navigation was used to identify the posterior ethmoid region, which was cleared off polyps and skull base identified. A seeker was used to open air cells along the lamina and skull base in retrograde fashion back to the frontal ethmoid region. Anterosuperior ethmoid air cells were opened and polyps removed with up-biting instruments. The ethmoid cavity was clear and afr in cottonoids applied . The same procedure was The maxillary antrostomy tissue removal and ethmoidectomy were completed on in identical fashion on the left side. Proceeding on the left, I used navigation and identified the natural opening of the f r ontal sinus. I introduced the Entellus balloon to expand the frontal tract and this was then converted to a formal frontal sinusotomy using up cutting forceps to take down the bony overhang and superior residual uncinate process creating a formal frontal sinusotomy. The left middle turbinate was pushed laterally and face was sphenoid was examined. Polyps were cleared from the face of the sphenoid with cutting forceps and the navigation used to identify the natural ostium, which was widened using cutting instruments. Middle turbinate was replaced toward the midline. Cottonoids were removed and Propel rnometasone implants were deployed bilaterally in the ethmoid cavity.
The inferior turbinates were then treated with the ArthroCare turbinate wand, which was used to pierce the tip of the left inferior turbinate and passed to the posterior third of the structure and activated for 10 seconds in the setting of 4. Additional lesions were made in the middle and anterior third of the turbinate. Mucosa was preserved and the body outfractured. This was repeated bilaterally. Hemostasis was present and the procedure was terminated as instruments and sponge counts were confirmed as correct.
Can anyone help me with all the CPT codes for the following procedures at ASC:
1) Bilateral image-guided endoscopic sinus surgery consisting of left endoscopic frontal sinusotomy with total ethmoidectomy
2)Left endoscopic sphenoid simusotomy
3) Bilateral maxillary antrostomies with tissue removal
4)Right endoscopic total ethmoidectomy
5) Bilateral inferior turbinate submucous resection using submucosal radiofrequency current
6) Bilateral insertion of Propel mometasone sinus implants
Dx:
1) Bilateral chronic maxillary and ethmoid sinusitis
2) Left-side frontal and sphenoid chronic sinusitis
3) Bilateral sinonasal polyposis
4) Inferior turbinate hypertrophy
My colleague codes 31276-LT, 31257-LT, 31255-RT, 31267-RT, 31267-LT, 30802, 61782, S1091. J32.4, J33.8, J34.3.
According to CPT guideline,:
1) 31276 is bundled with 31255, 31257;
2) S1091 is non-payable for ASC;
3) The status indicator is N for 61782, it is bundled with the primary procedure.
4) 30802 is for ablation, soft tissue not excision
My CPT codes are 31253-50, 31288-LT, 31267-50, 30140-50. Dx: J32.2, J32.0, J32.3, J33.8.
The middle turbinate attachments were injected with local anesthetic. The right-sided procedure was first undertaken. The middle turbinate was compressed laterally and straight cutting forceps were used to remove the polyps arising from medial surface of the structure without traumatizing the cribrifonn. Now middle turbinate was replaced toward the midline and polyps were removed from the inferior portion of the middle turbinate. Now, the uncinate process was palpated and excised from the lateral nasal wall removing polyps arising from this structure. The maxillary sinus ostium was widened anteriorly and posteriorly using side-biting forceps and up-biting forceps and polyps were removed f r om the sinus itself. The ethmoid bulla was opened and polyps were removed back through the basal lamella of the middle turbinate. Navigation was used to identify the posterior ethmoid region, which was cleared off polyps and skull base identified. A seeker was used to open air cells along the lamina and skull base in retrograde fashion back to the frontal ethmoid region. Anterosuperior ethmoid air cells were opened and polyps removed with up-biting instruments. The ethmoid cavity was clear and afr in cottonoids applied . The same procedure was The maxillary antrostomy tissue removal and ethmoidectomy were completed on in identical fashion on the left side. Proceeding on the left, I used navigation and identified the natural opening of the f r ontal sinus. I introduced the Entellus balloon to expand the frontal tract and this was then converted to a formal frontal sinusotomy using up cutting forceps to take down the bony overhang and superior residual uncinate process creating a formal frontal sinusotomy. The left middle turbinate was pushed laterally and face was sphenoid was examined. Polyps were cleared from the face of the sphenoid with cutting forceps and the navigation used to identify the natural ostium, which was widened using cutting instruments. Middle turbinate was replaced toward the midline. Cottonoids were removed and Propel rnometasone implants were deployed bilaterally in the ethmoid cavity.
The inferior turbinates were then treated with the ArthroCare turbinate wand, which was used to pierce the tip of the left inferior turbinate and passed to the posterior third of the structure and activated for 10 seconds in the setting of 4. Additional lesions were made in the middle and anterior third of the turbinate. Mucosa was preserved and the body outfractured. This was repeated bilaterally. Hemostasis was present and the procedure was terminated as instruments and sponge counts were confirmed as correct.
Can anyone help me with all the CPT codes for the following procedures at ASC:
1) Bilateral image-guided endoscopic sinus surgery consisting of left endoscopic frontal sinusotomy with total ethmoidectomy
2)Left endoscopic sphenoid simusotomy
3) Bilateral maxillary antrostomies with tissue removal
4)Right endoscopic total ethmoidectomy
5) Bilateral inferior turbinate submucous resection using submucosal radiofrequency current
6) Bilateral insertion of Propel mometasone sinus implants
Dx:
1) Bilateral chronic maxillary and ethmoid sinusitis
2) Left-side frontal and sphenoid chronic sinusitis
3) Bilateral sinonasal polyposis
4) Inferior turbinate hypertrophy
My colleague codes 31276-LT, 31257-LT, 31255-RT, 31267-RT, 31267-LT, 30802, 61782, S1091. J32.4, J33.8, J34.3.
According to CPT guideline,:
1) 31276 is bundled with 31255, 31257;
2) S1091 is non-payable for ASC;
3) The status indicator is N for 61782, it is bundled with the primary procedure.
4) 30802 is for ablation, soft tissue not excision
My CPT codes are 31253-50, 31288-LT, 31267-50, 30140-50. Dx: J32.2, J32.0, J32.3, J33.8.
