jaimewicklund
Guest
Hi folks-
So I am new to ENT coding (I typically code general surgery) so this may be elementary to most of you...but here goes. My doc wants to use cpt code 21336 for this procedure. I don't think this is correct. I am inclined to believe that 21336 is for current fractures that failed failed a closed reduction. This happened 12 years ago...no treatment...now deviated. Would this be a septoplasty??? Also, can anyone suggest where I might find guidelines for this to present if in fact I am correct? Thanks for taking a look!!!:
PREOPERATIVE DIAGNOSIS: Nasal obstruction.
POSTOPERATIVE DIAGNOSIS: Nasal obstruction.
PROCEDURE PERFORMED: Open reduction, nasal septal fracture.
INDICATIONS: Mr X is a 16-year-old who presents with a history of
nasal fracture when he was 4 years old. He fell down, severely
fracturing his nose. He did not get it fixed at that point, and ever
since that time he has had difficulty breathing through his nose. In
the office, he was noted to have about a 90-degree deflection of the
caudal septum.
FINDINGS AT THE TIME OF SURGERY: He was found to have again about a
90-degree deflection of the caudal septum. The caudal end stuck into
the right nostril, but he had a sharp convexity into the left nostril,
totally blocking that side of his airway. He also had a posterior bony
spur into the left side, and the maxillary crest was deviated over to
the left as well.
DESCRIPTION OF PROCEDURE: Once informed consent was obtained, he was
brought to the operating room and placed under general anesthesia. He
was prepped and draped in the usual fashion. Nose was injected with 1
percent lidocaine with epinephrine after decongestion with Afrin. An
incision was made along the ____________________ end of the septum in
the right nostril after prepping and draping. A mucoperichondrial flap
was raised back on the right side. A small tear was made, but this was
controlled. The flap was elevated without tearing, going posteriorly
back past the bony cartilaginous junction.
Attention was turned to the left side. Mucoperichondrial flap was
raised back on this side as well. Again, a small little tear was made
at the edge of the sharp angulation. However, it was controlled
actually very well. I was able to minimize it to almost nothing. Next,
raised back, going posteriorly, the caudal septum was just very flail
and completely almost separate from the remaining septum, and this was
removed. The remaining caudal septum had a deflection in the left side.
Using a swivel knife, this portion of cartilage was removed. It was
removed down to a small strip along the maxillary crest. This was taken
out and placed in saline on the back table. The lower crest was still
deviated to the left. This was fractured over. Bone was removed. The
strip of cartilage was removed and placed in saline as well.
There was a large bony spur going posteriorly on the left side into the
inferior turbinate. This was removed. Did get some minor tearing in
that area on the left side, not the right. Once this was done, the nose
was reexamined. There continued to be a little bit of caudal septum
deflected to the right. This was removed. The remaining dorsal strut
was in good shape. It was morcellized on its concave side to help
straighten it out. This did seem to straighten it out somewhat and move
it more towards the midline.
The large piece of quadrangular cartilage that was removed was
crosshatched to straighten it out. Once it was nice and straight, it
was placed back in the pocket and pulled anteriorly up to the crura. It
was sewn to the dorsal strut and to the mucosal flap. The inferior
strip of cartilage was then placed into the wound inferiorly along where
the maxillary crest had been removed. The flaps were then
reapproximated anteriorly using a chromic suture. A coaptation stitch
was then placed, and then splints were placed. He was turned back to
anesthesia, awakened, and taken to recovery.
So I am new to ENT coding (I typically code general surgery) so this may be elementary to most of you...but here goes. My doc wants to use cpt code 21336 for this procedure. I don't think this is correct. I am inclined to believe that 21336 is for current fractures that failed failed a closed reduction. This happened 12 years ago...no treatment...now deviated. Would this be a septoplasty??? Also, can anyone suggest where I might find guidelines for this to present if in fact I am correct? Thanks for taking a look!!!:
PREOPERATIVE DIAGNOSIS: Nasal obstruction.
POSTOPERATIVE DIAGNOSIS: Nasal obstruction.
PROCEDURE PERFORMED: Open reduction, nasal septal fracture.
INDICATIONS: Mr X is a 16-year-old who presents with a history of
nasal fracture when he was 4 years old. He fell down, severely
fracturing his nose. He did not get it fixed at that point, and ever
since that time he has had difficulty breathing through his nose. In
the office, he was noted to have about a 90-degree deflection of the
caudal septum.
FINDINGS AT THE TIME OF SURGERY: He was found to have again about a
90-degree deflection of the caudal septum. The caudal end stuck into
the right nostril, but he had a sharp convexity into the left nostril,
totally blocking that side of his airway. He also had a posterior bony
spur into the left side, and the maxillary crest was deviated over to
the left as well.
DESCRIPTION OF PROCEDURE: Once informed consent was obtained, he was
brought to the operating room and placed under general anesthesia. He
was prepped and draped in the usual fashion. Nose was injected with 1
percent lidocaine with epinephrine after decongestion with Afrin. An
incision was made along the ____________________ end of the septum in
the right nostril after prepping and draping. A mucoperichondrial flap
was raised back on the right side. A small tear was made, but this was
controlled. The flap was elevated without tearing, going posteriorly
back past the bony cartilaginous junction.
Attention was turned to the left side. Mucoperichondrial flap was
raised back on this side as well. Again, a small little tear was made
at the edge of the sharp angulation. However, it was controlled
actually very well. I was able to minimize it to almost nothing. Next,
raised back, going posteriorly, the caudal septum was just very flail
and completely almost separate from the remaining septum, and this was
removed. The remaining caudal septum had a deflection in the left side.
Using a swivel knife, this portion of cartilage was removed. It was
removed down to a small strip along the maxillary crest. This was taken
out and placed in saline on the back table. The lower crest was still
deviated to the left. This was fractured over. Bone was removed. The
strip of cartilage was removed and placed in saline as well.
There was a large bony spur going posteriorly on the left side into the
inferior turbinate. This was removed. Did get some minor tearing in
that area on the left side, not the right. Once this was done, the nose
was reexamined. There continued to be a little bit of caudal septum
deflected to the right. This was removed. The remaining dorsal strut
was in good shape. It was morcellized on its concave side to help
straighten it out. This did seem to straighten it out somewhat and move
it more towards the midline.
The large piece of quadrangular cartilage that was removed was
crosshatched to straighten it out. Once it was nice and straight, it
was placed back in the pocket and pulled anteriorly up to the crura. It
was sewn to the dorsal strut and to the mucosal flap. The inferior
strip of cartilage was then placed into the wound inferiorly along where
the maxillary crest had been removed. The flaps were then
reapproximated anteriorly using a chromic suture. A coaptation stitch
was then placed, and then splints were placed. He was turned back to
anesthesia, awakened, and taken to recovery.