# Endolymphatic sac enhancement - HELP!



## crhunt78 (Jan 30, 2012)

I am not an ENT coder at all and am trying to code the following procedure; the physican used codes 69436 & 69806.  I would really appreciate any help I can get!!

"Left facial nerve monitoring was applied in perioral and periocular areas.  On ce this was completed, preppeing of the ear was done.  Postauricular in jections, total of 6 to 7 mL were utilized.  Once this was performed, the patient was ready.  The postauricular incision was carried out down to the level of the periosteum, elevated anteriorly.  Subperiosteal elevation with dissection from the tip of the mastoid to sinodural angle cortically to the linea termporalis anteriorly was elevated periosteally to the level of spine of Henle.  Once this was retracted open with cerebellar retractors, the cortical mastoidectomy was carried out.  Sinus tegmen was developed, sinodural angle, as well as sigmoid sinus which was lateral posterior in this case.  The mastoid tip was elevated.  Posterior canal wall was thinned.  Koerner septum was taken down, and the aditus ad antrum was opened widely.  The incus was identified, short arm.  The lateral and posterior semicircular canal was identified.  On ce this was performed, posterior mastoid cortical inner table was taken down over the level of the cerebellum, down to the level of the dura of this area.  Once that was violated, the Donaldson line was demarcated.  Once we found the endolymphatic sac in the lateral and inferior segment of this triangular, the patient's endolymphatic sac was incised open with a sickle knife.  Whirly Bird was used to open the lumen. T-shaped and Silastic struts were cannulated into the lumen and then spacers superior and inferior to this sac was performed.  A large piece of Silastic was placed over the cortical defect, as well some Gel foam was packed laterally.  Once this was performed, the postauricular subdermaql tissues were closed in routine manner.  At this point, attention was placed to the left ventilation tube.

Anterior superior segment of the left drum head was incised with a sickle knife.  Using alligator and Rosen needle, the tube was transtympanically rotated in position.  Antibiotic drops of Ciprodex were placed and a cotton ball was positioned.  At this point, the wound was closed....etc.

Neuro-integrity monitoring was completed about 1 hour and 15 minutes for the facial nerve."

If anyone can help me, you will be my hero today!


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## blonde01 (Feb 8, 2012)

These look like the correct codes to me, but 69436 should be billed with modifier 59 as well.


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