Help, I am looking for advice on how to code these Tobramycin Flush procedures. Some backgound, these are performed mostly on patients with Cystic Fibrosis and they hve had previous sinus surgeries and the maxillary and etmoid sinus are wide open. I have described 3 seperatae examples. The closest code I can come up with is the 31000-Lavage by cannulation; maxillary sinus, or would it be more appropriate to bill an E/M with the drug being supplied?

Since in some of the notes there is no mention of cannulation of vasoconstriction performed would the 31000-52 be a better option?

Example #1 [/COLOR]
HISTORY OF PRESENT ILLNESS: This patient is in for his tobramycin flush. He had an infection in his sinuses last month, and was treated fairly vigorously for it. Mom thinks he is finally better. It has been 2 months since we did a tobramycin flush. She feels he definitely does better with this tobramycin flush. He did very well over the summer without one.

PHYSICAL EXAM: On my examination today, I see that the ear canals are clear. Nose is good right now, but Mom said he had a terrible cellulitis on the right side, but they had given him Bactroban and that has healed nicely now.

I did flush both the middle meatus with 40 mg of tobramycin in a soft syringe on both sides without difficulty.

[COLOR="Blue"]Example #2

EXAM: The nose actually looks pretty good. The mucosa is somewhat reddened throughout his nasal tissue and a little bit of old mucus on the bottom of the nose. I sprayed the nose and shrunk it up a bit and suctioned all this out prior to putting tobramycin flushes in, which I did. I increased him now to 60 mg on each side to see if that makes a difference. He tolerated the flush very nicely.
ADDENDUM: The flushing was done into the middle meatus bilaterally with a soft Intracath syringe.
The diagnosis remains the same, chronic ethmoid and maxillary sinusitis.

Example #3
EXAM: His nose looks just great. I did go ahead and flush both middle meatae with 60 mg of tobramycin on a soft-tipped syringe, and he has been tolerating this very, very well lately.

I would apprecaitae any advice anyone could offer.

Thank you in advance.