I have a case of Graves' disease where the patient had an orbital decompression via transconjunctival floor approach, recession retractors bilateral lower lids and lateral canthoplasty to elevate the lower lids. Please read the below op note and let me know how you would code this. I used 67414 LT 67950 LT and RT, 15820 LT and RT. Do you agree? Any help and any possible back-up information would be greatly appreciated! Thank you.
PREOP DX: Graves' disease, thyroid related opththalmopathy, exophthalmus, exposure keratoconjunctivitis.
POSTOP DX: Same
Incision was made along the orbital rim through the periosteum just 2 mm below the orbital rim. A freer elevator was then used to elevate the periosteum and lift the periosteum off the floor of the orbit. A ring retractor was used to retract the eye and then the floor was cleared of periosteum. I extended this all the way toward the infraorbital nerve.
At this point periosteum was incised and that was key to allow it to prolapse further into the ostomy. The eye was noted to be significantly less prominent and the lower eyelid was elevated by performing a lateral canthoplasty. Then 2 or 3 mm of skin was removed over the tarsus temporally from the upper and lower eyelids and then 5-0 Vicryl suture was used to suture from the wound out to the de-epithelialized are of tarsus and below it back through the upper lid and then tied in the wound.
PREOP DX: Graves' disease, thyroid related opththalmopathy, exophthalmus, exposure keratoconjunctivitis.
POSTOP DX: Same
Incision was made along the orbital rim through the periosteum just 2 mm below the orbital rim. A freer elevator was then used to elevate the periosteum and lift the periosteum off the floor of the orbit. A ring retractor was used to retract the eye and then the floor was cleared of periosteum. I extended this all the way toward the infraorbital nerve.
At this point periosteum was incised and that was key to allow it to prolapse further into the ostomy. The eye was noted to be significantly less prominent and the lower eyelid was elevated by performing a lateral canthoplasty. Then 2 or 3 mm of skin was removed over the tarsus temporally from the upper and lower eyelids and then 5-0 Vicryl suture was used to suture from the wound out to the de-epithelialized are of tarsus and below it back through the upper lid and then tied in the wound.