nsteinhauser
Expert
Need another set of eyes to take a look at this one. Wondering if 30420 would be the appropriate code for the following:
We then turned to the septoplasty. A 15 blade was used to make a hemitransfixion incision. Mucoperichondrial flap was elevated to the bony cartilaginous junction and inferiorly along a large left-sided septal spur. The bony cartilaginous junction was fractured with an Anderson-McCullough. A 15 blade was used to make a cartilaginous cut, leaving at least 1.5 cm dorsal and caudal strut. The mucoperichondrial flap was elevated on the contralateral side. The cartilage was fractured off the maxillary crest and kept for potential future use. The periosteum was elevated off the maxillary crest, and using double-action scissors the maxillary crest was removed. The perpendicular plate of the ethmoid bone was isolated on both sides from the periosteum. Double-action scissors were used to make multiple cuts into this and remove the deviated portions of the ethmoid bone. The nasal airway was assessed and deemed to be widely patent. At this point, we turned our attention to the osteotomies. On the left side, an incision was made with a 15 blade superolateral to the inferior turbinate. A Joseph elevator was used to elevate the periosteum for the lateral osteotomy. This was brought up to the level midway between the medial canthus and the nasal dorsum. A curved osteotome was used to create the osteotomy. This was also performed on the right side. Pressure was then used to greenstick the nasal dorsum back into alignment. Adequate reduction was obtained. Closure then commenced. A 4-0 chromic was used to close the hemitransfixion incision. A 3-0 chromic was then used to do a quilting suture within the nasal septum. Doyle splints were placed in the nose and secured with a 3-0 nylon. Benzoin and Steri-Strips were placed in the nasal dorsum. An Aquaplast cast was placed on top of it. This concluded the procedure. The patient tolerated the procedure well without issue and was turned over to anesthesia in stable condition.
I'm assuming the nasal dorsum curvature contributed to overall obstruction of the airway, along with the deviated septum. No former fractures noted. If this isn't an appropriate code, what would you code, if anything, in addition to the 30520?
Thank you for any and all comments!
We then turned to the septoplasty. A 15 blade was used to make a hemitransfixion incision. Mucoperichondrial flap was elevated to the bony cartilaginous junction and inferiorly along a large left-sided septal spur. The bony cartilaginous junction was fractured with an Anderson-McCullough. A 15 blade was used to make a cartilaginous cut, leaving at least 1.5 cm dorsal and caudal strut. The mucoperichondrial flap was elevated on the contralateral side. The cartilage was fractured off the maxillary crest and kept for potential future use. The periosteum was elevated off the maxillary crest, and using double-action scissors the maxillary crest was removed. The perpendicular plate of the ethmoid bone was isolated on both sides from the periosteum. Double-action scissors were used to make multiple cuts into this and remove the deviated portions of the ethmoid bone. The nasal airway was assessed and deemed to be widely patent. At this point, we turned our attention to the osteotomies. On the left side, an incision was made with a 15 blade superolateral to the inferior turbinate. A Joseph elevator was used to elevate the periosteum for the lateral osteotomy. This was brought up to the level midway between the medial canthus and the nasal dorsum. A curved osteotome was used to create the osteotomy. This was also performed on the right side. Pressure was then used to greenstick the nasal dorsum back into alignment. Adequate reduction was obtained. Closure then commenced. A 4-0 chromic was used to close the hemitransfixion incision. A 3-0 chromic was then used to do a quilting suture within the nasal septum. Doyle splints were placed in the nose and secured with a 3-0 nylon. Benzoin and Steri-Strips were placed in the nasal dorsum. An Aquaplast cast was placed on top of it. This concluded the procedure. The patient tolerated the procedure well without issue and was turned over to anesthesia in stable condition.
I'm assuming the nasal dorsum curvature contributed to overall obstruction of the airway, along with the deviated septum. No former fractures noted. If this isn't an appropriate code, what would you code, if anything, in addition to the 30520?
Thank you for any and all comments!