pfwilliams39
Contributor
Please read the op report below and advise: I was using cpt code 30130 because the first action stated he incised with a blade a removed bone. The physician request is to bill the 30802. The physicians documentation supports all three, so which code should be used?
Once this was complete, we used a D-knife to make an incision leaving a 1.5 cm L-strut to the contralateral side of the septum. Once the incision was made, the Cottle elevator was again used to bluntly dissect in the submucoperichondrial plane, elevating in a continuous plane overlying the quadrangular cartilage, perpendicular plate, vomer, and again separating the decussating fibers of the maxillary crest. With both flaps elevated, we were able to visualize directly significantly deviated portion of the septum including redundant quadrangular cartilage. This was removed using a dorsal scissors to make an inferior cut and remove a sliver of this cartilage approximately 10 mm in height. This was dissected free from the maxillary crest and removed with a Takahashi forceps. Once this was complete, the bony cartilaginous junction was separated and a cut was made in the bony portion of the septum using a double-action Jansen-Middleton. Then, the deviated portions of the perpendicular plate as well as the vomer were removed with a Takahashi forceps. Once this was complete, the septum was backed midline. The septal flaps were closed using quilting stitch, and the incision was closed using similar interrupted sutures.
We then turned our attention to the inferior turbinate reduction. Bilateral heads of the inferior turbinates were visualized directly and incised with a #15 blade. The Cottle elevator was used to elevate the submucoperiosteal flaps overlying the entirety of the bilateral inferior turbinates. Once this was complete, the 2-mm shaver blade was inserted into the flaps atraumatically. It was used to thin overlying mucosa as well as remove small portions of the bony inferior turbinates bilaterally. Once this was complete, the ablate function of the device was used to further thin the overlying mucosa as well as maintain hemostasis, and this was completed bilaterally as well. At this time, under direct visualization, a Boies elevator was used to outfracture the bilateral inferior turbinates. Once this was complete, the procedure was completed, and hemostasis was adequate.
Once this was complete, we used a D-knife to make an incision leaving a 1.5 cm L-strut to the contralateral side of the septum. Once the incision was made, the Cottle elevator was again used to bluntly dissect in the submucoperichondrial plane, elevating in a continuous plane overlying the quadrangular cartilage, perpendicular plate, vomer, and again separating the decussating fibers of the maxillary crest. With both flaps elevated, we were able to visualize directly significantly deviated portion of the septum including redundant quadrangular cartilage. This was removed using a dorsal scissors to make an inferior cut and remove a sliver of this cartilage approximately 10 mm in height. This was dissected free from the maxillary crest and removed with a Takahashi forceps. Once this was complete, the bony cartilaginous junction was separated and a cut was made in the bony portion of the septum using a double-action Jansen-Middleton. Then, the deviated portions of the perpendicular plate as well as the vomer were removed with a Takahashi forceps. Once this was complete, the septum was backed midline. The septal flaps were closed using quilting stitch, and the incision was closed using similar interrupted sutures.
We then turned our attention to the inferior turbinate reduction. Bilateral heads of the inferior turbinates were visualized directly and incised with a #15 blade. The Cottle elevator was used to elevate the submucoperiosteal flaps overlying the entirety of the bilateral inferior turbinates. Once this was complete, the 2-mm shaver blade was inserted into the flaps atraumatically. It was used to thin overlying mucosa as well as remove small portions of the bony inferior turbinates bilaterally. Once this was complete, the ablate function of the device was used to further thin the overlying mucosa as well as maintain hemostasis, and this was completed bilaterally as well. At this time, under direct visualization, a Boies elevator was used to outfracture the bilateral inferior turbinates. Once this was complete, the procedure was completed, and hemostasis was adequate.