Subglottic Tracheal Stenosis

Bobby A

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Dittmer , MO
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Can someone help me with this. I was thinking 31528 for one of the codes but I am just lost.
Pre-op Diagnosis: Subglottic tracheal stenosis
Post-op Diagnosis: same
Procedure Performed:  Microsuspension laryngoscopy, bronchoscopy, resection of tracheal stenosis, balloon dilation with Boston balloon with mitomycin-C, Kenalog injection.

DESCRIPTION OF PROCEDURE:
Patient was brought in the operating room and placed on table in supine position.  After good mask airway was able to be achieved, Dedo laryngoscope was put into place and suspended over tooth guards.  Given the patient's quick desaturations, patient was intubated through the scope as needed throughout the case.  Initially, a 5.0 tube was placed.  Following dilations, a 6-1/2 was able to be placed.  The subglottic tracheal stenosis was visualized using the bronchoscopic telescope.  Incisions were made at 9:12 a.m. and 3:00 a.m. with a Omni guide CO2 laser.  Mitomycin-C coated Boston balloon was then employed  to dilate the stenosis twice.  The patient could withstand only approximately a minute and half of dilation.  Following this, Kenalog 40 was injected along the periphery of the stenosis.  The patient appeared to tolerated the procedure well.  She was intubated at the end of the case with a 6 and half tube .  At this time, she is in the process of being extubated.  She appears to have tolerated the procedure well.

Thank you
 

b.cobuzzi

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31570: Laryngoscopy, direct, with injection into vocal cord(s), therapeutic
31540: Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis (lasar destruction of stenosis)
31528: Laryngoscopy direct, with or without tracheoscopy; with dilation, initial

Surgeon should have indicated if the dilation was initial or a subsequent dilation. I am making an assumption here.
 
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