dr. wants to bill cpt 30520 & 30140 but the op note states external nasal deformity with infracture,

DX: traumatic nasal deformity & septal deviation

operation: correction of external nasal deformity with infracture and septoplasty with inferior turbinate resection

Brief Clinical History:

patient sustained an injury to hernose when she fell. this occurred and initially was documented in an emergency room, but not treated. patient since the history of collapse to the left nasal bone, the right internal valve was also impacted by the force. the patient required relocation of septum back into the midline. reduction of turbinate to prevent proper bleeding and relocation of medial crura in center once the septum has been straightened. the patient would have also the nasal bone removed and the nasal bone is symmetrically infractured to obtain symmetry.

Operative Procedure:
After endotracheal anesthesia was obtained. the patient hada transmembranous incision made, elevation of the nasal dorsum. the most deviated septum was completed removed with a #11 blade scalpel and the vomerine element of the degraded septum in the right airway was relocated back to midline with osteotomy.

The patient then had the impacted nasal bone addressed that shows asymmetrically fracture in the nose with a 2mm osteotome and then elevating the nose intranasally and instrumentally. Then, the small nasal bone was rasped conservatively. A curette was used to assure there were no nasal fragments in the area and then the patient had the nasal cast placed in the nasal dorsum to maintain the nose, which was straight at this point. The medial crura footplates were then secured back in midline. Any extensive hypertrophic inferior turbinates were electively suctioned and cauterized and the excessive burn tissue removed. The patient then had bacitracin and nasal packing placed in both airways so that she would breathe through the mouth and to prevent any excessive swelling.