# Need Guidance on Rhino/Septo -plasty



## nsteinhauser (Jan 27, 2010)

Hi there. I'm not sure what to do here - this is the op note - 

.....a tranfixion incision was made. The patient had significant caudal septal deviation to the right side obstructing his nasal airway.  Mucoperichondrium was then raised both caudally and superiorly and the caudal septum that was deviated was then excised.  This relieved his airway, so we decided at this point to just close the transfixion incision with 3-0 chromic.  Once this was done, the Colorado micro needle was used to incise the mucosa of the inferior turbinates.  The hypertrophy was mostly mucosa, so the caudal mucosa was then excised as a strip.  The base was cauterized and Kenalog 10 was then injected into the remaining superior turbinate.  A similar procedure was carried out on the opposite side.  At this point his nasal airway obstruction appeared to be relieved so an intracartilaginous incision was made on the right side and the elevator was then passed into the nasal dorsum.  A rasp was then used to bring down the nasal hump to the previously marked lines.  Once we were satisfied that the hump had been brought down the wound was irrigated and at this point since he had such a broad nasal tip we decided to do a conservative cephalic resection of his alar cartilages.  This was performed through the same incision on both sides and the mucosa was closed with 5-0 plain gut suture.  Bacitricin soaked Gelfoams were then place into each nostril and Steri-Strips were applied to the nasal dorsum. 

...I don't know if rasping the nasal hump is enough to support a rhinoplasty code... so would you use a 30520 and a 30140-50?  ANything additional for the alar resection and nasal hump rasping?  Any help would be greatly appreciated!


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## magnolia1 (Jan 27, 2010)

I think you would be okay with 30420 and 30140-50


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## nsteinhauser (Jan 27, 2010)

Thank you for responding!  Please excuse my denseness on this  - so the surgeon doesn't have to fracture nasal bones to use the 30420?


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