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nasal septal flap

  1. #1
    Default nasal septal flap
    Medical Coding Books
    Any help with cpt coding for this op is greatly appreciated. Wasn't sure if 30465 should be used.

    ----- is a 39-year-old male seen in consultation for nasal
    breathing problems. ----- has had previous nasal surgery. He still
    reports difficulty breathing through the left side of his nose. On
    physical examination, he has redundant left septal mucosal tissue creating
    a medial obstruction of the internal nasal valve. I recommended repair
    with a nasal septal flap to open up the left nasal airway. The risks,
    complications, alternatives, and benefits were reviewed. Informed consent
    was obtained.

    REPORT: ----- was brought to the operating room and placed supine. The
    department of anesthesia administered general anesthetic via LMA. The face
    was then prepped and draped in the usual fashion. One percent lidocaine
    with 1:100,000 epinephrine was infiltrated locally. Afrin nasal spray was
    applied topically. Redundant left septal mucosal tissue was noted at the
    mucocutaneous junction. An elliptical incision was created at the junction
    and the redundant mucocutaneous tissue was excised down to the
    perichondrium. The left septal mucosa was then elevated posteriorly and
    advanced. The defect was reapproximated with 5-0 plain gut in simple
    interrupted fashion. This opened up the intranasal valve medially.
    Bleeding was self limiting. Additionally, a right marginal rim stab
    incision was created and subcutaneous dissection was performed of the right
    upper lateral cartilage in the area of the previous abscess and cellulitis
    to break up any loculations and to allow for subcutaneous irrigation with
    lidocaine with epinephrine. Bimanual palpation was then performed along
    the right nasal ala. Bleeding was self limiting.

  2. #2
    Default 30465 requires an osteotomy
    I believe 30520 fits this description best since bone was not cut and this includes local graft

    Here is the description of 30520

    The physician reshapes the nasal septum, correcting airway obstruction. Topical vasoconstrictive agents are applied to shrink the blood vessels and local anesthesia is injected in the nasal mucosa. The physician makes a vertical incision in the septal mucosa and elevates the mucoperichondrium from the septal cartilage. The deviated portion of the bony and cartilaginous septum is excised or augmented by grafting. Local grafts from adjacent nasal bones and cartilage are not reported separately. If the cartilaginous septum remains bowed, partial or full-thickness incisions are made in the cartilage to straighten the septum. Excess cartilage is excised from the bone-cartilage junction. Incisions are closed in single layers. Transseptal sutures are placed. Septal splints may support the septum during healing.
    Catherine Burroughs, CPC

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