Question New and confused!

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Colorado Springs, CO
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Can someone offer their expertise on this one? I am new to coding and new to the ENT specialty as well. My providers do this procedure quite often and I want to make sure I understand what tools are being used in these cases. Would codes 31541 and 31630 be appropriate codes for the case below? I am having a hard time finding where the bronchoscope was used. Any help is much appreciated!


OPERATION PERFORMED:
Microlaryngoscopy and bronchoscopy with subglottic stenosis, lysis and dilation.

PREOPERATIVE DIAGNOSIS:
Idiopathic subglottic stenosis.

POSTOPERATIVE DIAGNOSIS:
Idiopathic subglottic stenosis.
DESCRIPTION OF THE PROCEDURE:
The patient was met in the preoperative holding area where all of her questions were answered. Next, she was brought back to the operating room by the anesthesia team where she was transferred to the operating table and placed in the supine position, sedated, and mask ventilated. Once it was confirmed that she was easy to ventilate via mask by the anesthesia team, the table was turned 90 degrees to me. I took over managing the mask while the equipment was set up and brought in. Next, I used a tooth guard to protect the upper dentition. I placed a Lindholm laryngoscope into the vallecula and placed this on suspension with the Benjamin-Parsons to the Mayo stand. Using the 0-degree endoscope, I visualized the subglottic narrowing approximately a 1 cm to 1.5 cm below the vocal cords narrowing to approximately 8-9 mm. The ciatricial of the narrowing was along the 6 o'clock to 12 o'clock position. I lysed this while utilizing jet ventilation utilizing the OmniGuide CO2 fiber on the setting of 6 watts superpulse at the 12 o'clock, 9 o'clock, and 7 o'clock position intermittently ventilating the patient. Next, I used the Acclarent 14 mm balloon and accomplished 3 dilations each for 30 seconds apiece opening the airway nicely. The procedure was then terminated without any complications noted. The Lindholm was taken off suspension, removed and the tooth guard removed and care of the patient returned to the anesthesia team, who awakened the patient and transferred her to the PACU without any complications noted. The patient's lowest saturation was 78% during the procedure and she did quite well.
 

fwnewbie

True Blue
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New Haven, IN
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"..using the 0-degree endoscope" -there's your bronchoscope to visualize past the vocal cords. The laryngoscope only reaches deep enough to visualize the cords and the endoscope is guided down the throat, past the cords where the narrowings were lysed by laser followed by balloon dilations to further stretch the area.
I am not an ENT specialist, but I have seen a lot of surgery and can visualize this procedure from it's description. Also, I don't have my coding books out so can't say anything about your codes, but I hope my explanation helps.
 
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