Hi! Could someone please read through this op and tell me what procedure codes you would apply? I used 67414 LT, 67950 LT and RT and 15820 LT and RT. We're wondering about the 15820 if it can be coded separately. Any verifying documentation would be very helpful. The endoscopic portion of the procedure was dictated separately and coded separately from this portion. Thank you so much for reviewing this portion!

PREOP DX: Graves' disease, thyroid related ophthalmopathy, exophthalmus, exposure keratoconjunctivitis.


PROCEDURE: Orbital decompression via transconjunctival floor approach, recession retractors bilateral lower lids and lateral canthoplasty to elevate the lower lids.

Following sterile prep and drape a lateral canthotomy and inferior cantholysis was performed with Westcott Scissors. Bipolar cautery was used for hemostasis. Two silk stay sutures were placed in the lower lid for traction and then incision was made a few mm below the tarsus. This was performed with a cutting cautery and Colorado needle. DIssection was made down to the orbital rim. There was noted to be significant proptosis on this and was difficult. Incision was made along the orbital rim through the periosteum just 2 mm below the orbital rim. A freer elevator wasthen used to elevate the periosteum and lift the periosteum off the flooor of the orbit. A ring retractor was used to retract the eye and then the floor was cleared of periosteum. I was able to find the edge of Dr. Davis' decompression at the medial floor (that portion done endoscopically by separate surgeon) and I was able to extend it further without fracturing the bone with a freer elevator. I extended this all the way toward the infraorbital neve.

At this point the periosteum wasincised and that was key to allow it to prolapse further into the ostomy. At this point 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 area of tarsus and below it back through the upper lid and then tied in the wound. We closed the lateral canthal incision and stay sutures were removed.

Dr. Davis then went back in the nose to check for bleeding. There was none.