# help with nose surgery



## BFAITHFUL (May 24, 2009)

dx: ostructive breathing, left septal deviation, left internal nasal valve collapse, & bilateral inferior turbinate hypertrophy

operation: septoplasty, bilateral inferior turbinectomy, plication of inferior triangular footplates, fascial graft from the scalp with release of internal nasal valve & cartilage spreader graft


patient is a female who fractured her nose a number of years ago when someone struck her with an elbow. patient has been receiving consultation and has a very significant deviation of septum. patient will not have any nasal bone surgery. there will be just a small lowering of the tip of the nose so that some of the cartilage can be used as a partial spreader graft and the patient will also have fascial grafting also to further expand and maintain the correction. 

patient had a transmembranous incision made most distal deviated caudal septum resected as well as the nasal spine. With this done, the pa tient had access to the inferior turbinates bilaterally, I therapeutically suction cauterized the overhanging bony wing, which reduced this bony area and the turbinates approx. 50%. then patient had the septal flaps raised posteriorly and the deviated septum then insitu morcellized so that the septum was straight. to maintain the straightness, internally I splint these approximately three weeks postoperatively with silicone sheets tied with 3-0 nylon.

the patient at this point then had the nasal dorsum slightly lowered with a #15 scalpel and some of the left upper lateral cartilage, which was collapsed, freed and a small spreader graft placed obtaining cartilage from the opposite upper lateral cartilage. to maintain this position, the patient had a incision made in the left parietal scalp and a fascial graft obtained. the fascial grafts measured 2cm x 1cm. the donor site was closed and the fascial grafts were then secured over the released valve and secured also on to the part of th dorsum, with though and through sutures of 3-0 chromic. the sutures were also placed to the skin with 3-0 nylon, with these placed, the patient had a securing of the grafts and maintenance of the internal nasal valve was noted intranasal as well as externally. the nose itself was also straightened due to the placement of x 1cm plastic splint. 

your help is appreciated.

30520, 30130-50, (30465 ??)


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## rajalakshmir (May 25, 2009)

cpt 30520 [column 2 code ] to 30465 ,but here spreader graft is placed for collapsed cartilage which suits cpt 20912 but it is for for later use in an autologous reconstructive procedure and the cpt 30465 seems to be reduced procedure since no osteotomy performed .so i think the cpt codes are 30465 - 52 ,30130


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