# Excision of rt middle turbinate?



## MELJNBBRB (Apr 28, 2015)

PREOPERATIVE DIAGNOSIS(ES):



Hi list! I have coded 31256-50
31255-50
31276-50
30802-50
I am not sure what to assign for the excision of the rt middle turbinate? Any guidance is appreciated. Still learning these surgeries.

TIA
M,CCS,CPC


1. Chronic pansinusitis.

2. Turbinate hyperplasia.



POSTOPERATIVE DIAGNOSIS(ES):

1. Chronic pansinusitis.

2. Turbinate hyperplasia.



PROCEDURE(S)/OPERATION(S) PERFORMED:

1. Bilateral endoscopic maxillary antrostomies.

2. Bilateral endoscopic total ethmoidectomies.

3. Bilateral endoscopic frontal sinusotomies.

4. Bilateral inferior turbinate Coblation.

5. Excision of right middle turbinate.



ANESTHESIA:

General endotracheal anesthetic.



ESTIMATED BLOOD LOSS:

Less than 50 mL.



FLUIDS:

900 mL crystalloid.



COMPLICATIONS:

None.



FINDINGS:

1. Thickened and inflamed polypoid mucosa throughout.

2. Bilateral inferior turbinate hyperplasia.

3. Packing nasopore x2 with Kenalog.



INDICATIONS FOR SURGERY:

The patient has chronic pansinusitis despite the use of maximal

medical management.  She is here for definitive treatment.



SUMMARY:

After properly identifying the patient, she was brought to the

operating room, placed on the operating room table, and placed

under adequate general endotracheal anesthetic without

difficulty.  A time-out was performed prior to beginning the

procedure.



The patient was registered with the fusion navigation device

without difficulty.  A throat pack was placed.  Her nose was

packed with Afrin and Afrin pledgets.



Using the zero-degree endoscope, the left side was addressed 1st.

The middle meatus was entered.  The uncinate process was

identified.  Backbiting forceps were used to take down or to

incise the uncinate and then a right angle probe was used to

enter the natural os of the maxillary sinus.  I then pulled the

remaining uncinate process anteriorly and uses the 0 degree

shaver to completely take down the uncinate.  I then used the

registered shaver to take down the ethmoid bulla, and followed

all the way up to the skull base and then followed the skull base

posteriorly taking down air cells until the anterior wall of the

sphenoid was identified.  I then used powered and manual

debridement to take down all the air cells in the ethmoid bed

verifying a completion of the dissection with image guidance.

During the removal of the anterior air cells using the upbiting

forceps to really opened up the maxillary and the frontal sinus

opening and then inserted the image guided frontal sinus seeker

and was able visibly see the opening of the frontal sinus with

the 45 degree scope and verified the opening into the frontal

sinus with the image guidance.  Next, the left maxillary sinus

was widely opened with the shaver and manual debridement until

the entire sinus was opened and a visible through the 45 degree

scope.  The same procedure was then performed on the right side

without change of procedural details or findings except for the

fact that I did take down the middle turbinate on the right side

because of it being somewhat paradoxical in shape and really

wanting to stay lateral.



Once both at the sinus beds were widely patent.  I then injected

local anesthetic into the inferior turbinates, and performed

Coblation on a setting of 6 and 2.  Three passes were made

through each inferior turbinate.  I then placed nasal pore into

both middle meatus and injected with about 1 mL of Kenalog 40 on

each side.  At this point, the throat pack was removed.  The

patient was turned back over to Anesthesia.  The patient was

awakened and extubated in operating room to recovery room in

stable condition.


----------



## lmeadows (Jun 16, 2015)

You would not code the excision of the middle turb. The middle turb provides access to the sinus cavities, so it is included in the sinus code.


----------



## MELJNBBRB (Jun 16, 2015)

thanks for your reply, yes, that is what I ended up coming up with as well.


----------



## jvanbk (Mar 17, 2017)

*Multiples FESS sinus surgeries*

Question -- in the scenario you discussed, would you add -51 modifiers to the last three?

31255-50
31276-50
30802-50

(Sorry but I am brand new at this).

Thanks,
jennifer


----------

