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Thread: retromolar trigone - removal of foreign body

  1. #1
    Join Date
    Apr 2007

    Default retromolar trigone - removal of foreign body

    AAPC: Back to School
    Please - any help you can give in coding this one would be much appreciated.

    ]INDICATIONS FOR PROCEDURE: The patient is a 5-year-old girl who was
    undergoing a dental procedure and during the nerve block portion of the
    procedure, the needle was dislodged and lost in the soft tissues around the
    retromolar trigone. The foreign body was confirmed by x-ray and
    subsequently she was sent to an oral surgeon for operative retrieval. At
    an outside institution, they were unable to achieve this, and she was
    subsequently sent to the otolaryngology clinic for further treatment.
    She was taken to the OR for concerns
    of worsening dysphagia, nausea and vomiting.

    PROCEDURE IN DETAIL: After informed consent was obtained from the
    patient's parents, the patient was taken to the operating room and placed
    supine on the operating room table. A 4.5 endotracheal tube was placed.
    After successful induction, the patient was turned 180 degrees and prepped
    and draped in standard sterile manner. A McIvor mouth retractor was used
    to place the patient into suspension on the Mayo stand and a smiley mouth
    retractor was used to expose the soft tissues of the right retromolar

    The prior incision was opened with Bovie electrocautery on cut, and using a
    Kelly clear to auscultation and percussion, the soft tissues around the
    retromolar trigone were dissected. We initially tried to verify the
    position with the ultrasound. However, we were unable to identify the
    needle on ultrasound. The C-arm was therefore used to verify the position
    of the needle.

    The needle appeared to be located medial to the ascending ramus of the
    mandible imbedded in the soft tissues posterior and superior to the right
    retromolar trigone. We therefore dissected in this plane, and on multiple
    shots with the C-arm, we used a spinal needle to try to localize the
    foreign body. However, we were unable to directly visualize the foreign
    body and the C-arm was incapable of shooting in a lateral plane and was not
    able to shoot through the bed. Therefore, after significant dissection
    around the retromolar trigone posteriorly and posteriorly towards the
    pterygoid plates, we decided to abort the procedure after several hours.
    Surgicel was placed into the wound bed and the incision closed with
    interrupted 3-0 Vicryl sutures.

    The patient was turned back to anesthesia, extubated in the operating room
    and wheeled to the recovery room in stable condition.

  2. #2
    Join Date
    Apr 2007
    Jacksonville Florida Chapter

    Default Try this....

    76998-26 to charge for the intraoperative ultrasonic guidance, even though they couldn't find the needle with it.

    41805-53 for the attempted unsuccessful removal of the needle.

    I was thinking that you might be able to code the endotracheal intubation using 31500, but I don't think you can because part of the definition of the code includes "emergency procedure" and I don't feel as though this could be considered an emergency procedure.

    Also, since a C-arm was used, you might want to go back and ask the surgeon if it was used radiographically or fluoroscopically so you could code that too.
    John Meyer, CPC-A
    Heekin Orthopedic Specialists

  3. #3


    Perhaps 10121-53 because it doesn't quite sound like Dr was in the actual "Structures" but more in the soft tissue mid-ramus.

    As with Pogiest, I'd also code a -26 on whatever "radio" the Dr did but make sure dr has a separate report with indications and findings. Didn't happen if there isn't a separate report.

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