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staged revision???

  1. #1
    Default staged revision???
    Medical Coding Books
    I am not sure how I should code this?? It does not seem to fit under a rhinoplasty.. Should I just code the grafts and W-plasty??

    PREOPERATIVE DIAGNOSIS: Nasal deformity from CPAP injury with
    necrosis of columella.

    POSTOPERATIVE DIAGNOSIS: Nasal deformity from CPAP injury with
    necrosis of columella.

    PROCEDURE PERFORMED: Staged revision of forehead flap with cartilage
    grafting to nasal tip, W-plasty inset, reconstruction of soft
    triangle and columella, and reduction of columella flap.


    DESCRIPTION OF PROCEDURE: Under general anesthesia, the patient was
    prepped and draped in the usual sterile fashion. Marcaine with
    epinephrine was injected to the left ear. A postauricular incision
    was made. Previous ear cartilage has been harvested from this ear,
    but there is residual cartilage left. So, rather than harvest from
    the contralateral ear, the remaining cartilage was needed was
    harvested from the conchal bowl. After the conchal bowl cartilage
    was harvested, it was wrapped in a saline-soaked gauze and preserved.
    Meticulous hemostasis was obtained and the postauricular incision
    was closed with Histoacryl and chromic sutures. A Glasscock splint
    was then placed at the end of the case.

    Attention was then directed to the columella where, after the
    injection was given, an indentation in the columella where there was
    a disjunction between the forehead flap and the remainder of the nose
    was identified. A W-plasty incision was made in this area to open to
    tip to allow for joining these areas. Cartilage grafting to the
    columella and then the domes was then performed. The cartilage was
    sewn in place with 5-0 PDS suture. This included a soft triangle of
    cartilage in this area. Once the soft triangle was created, the
    W-plasty incisions were then inset, eliminating the large defect that
    was present with the indentation in this area. Laterally, because of
    bulkiness of the columella with a hanging columellar deformity, the
    graft was debulked and then sewn laterally into the lateral part of
    the columella. This tightened the columella and got rid of the
    hanging deformity. This was sewn with multiple resorbable sutures.

    At the end of the case, nasal splints were placed with no pressure on
    the nose, with extreme care taken to place no pressure on the
    columella so as not to cause any problems with vascular liability.

    The patient tolerated the procedure well with no complications. The
    patient was sent to recovery in good condition.

  2. #2
    Location
    Rose City Chapter
    Posts
    42
    Default Flap revision
    Here is how I see it...

    DESCRIPTION OF PROCEDURE: Under general anesthesia, the patient was
    prepped and draped in the usual sterile fashion. Marcaine with
    epinephrine was injected to the left ear. A postauricular incision
    was made. Previous ear cartilage has been harvested from this ear,
    but there is residual cartilage left. So, rather than harvest from
    the contralateral ear, the remaining cartilage was needed was
    harvested from the conchal bowl. After the conchal bowl cartilage
    was harvested, it was wrapped in a saline-soaked gauze and preserved.
    Meticulous hemostasis was obtained and the postauricular incision
    was closed with Histoacryl and chromic sutures. A Glasscock splint
    was then placed at the end of the case.[

    For the above paragraph, I suggest 21235 for the harvest of the cartilege graft

    Attention was then directed to the columella where, after the
    injection was given, an indentation in the columella where there was
    a disjunction between the forehead flap and the remainder of the nose
    was identified. A W-plasty incision was made in this area to open to
    tip to allow for joining these areas. Cartilage grafting to the
    columella and then the domes was then performed. The cartilage was
    sewn in place with 5-0 PDS suture. This included a soft triangle of
    cartilage in this area. Once the soft triangle was created, the
    W-plasty incisions were then inset, eliminating the large defect that
    was present with the indentation in this area.

    For the above paragraph I suggest 30430 or 30400 (depending on primary or secondary). The W-plasty is only made here to lift the nose open to work on it and for a better cosmetic result when the nose is closed, and should not be reported separately

    Laterally, because of bulkiness of the columella with a hanging columellar deformity, the
    graft was debulked and then sewn laterally into the lateral part of
    the columella. This tightened the columella and got rid of the
    hanging deformity. This was sewn with multiple resorbable sutures.

    If the original code for previous surgery was the forehead flap 15731, and if the flap mentioned in this last paragraph above is the flap the provider is debulking then you could use 14060 for the debulking per parenthetical guideline on page 73 of 2011 CPT book underneath the code 15650. Of course, this is without having read the original surgery.

    For ICD's I would use acquired deformity of the nose, with an injury code to reflect the indication for the surgery.

    Of course, these are only suggestions, but it is how I see it. I hope this helps...

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