# Help!  Multiple nasal procedures



## smcbroom (Jun 19, 2008)

I have a commercial claim and I think I have the first codes correct: 
1.  21320
2.  30520?
3.  30140 50 52
4.  30999???????

If someone can assist me with these, I would be truly grateful.

OPERATIVE PROCEDURE:
1.  Closed reduction of the nasal fracture.
2.  Open reduction of the septal fracture dislocation (septoplasty).
3.  Bilateral inferior reduction turbinoplasties.
4.  Bilateral intranasal osteotomies.
DESCRIPTION OF THE PROCEDURE:
The patient was brought to the operating room.  Endotracheal intubation was carried out by Dr. David Mock.  Both sides of the patient's nose were packed with 1/2?inch gauze impregnated with 4% cocaine solution.  A suitable interval was allowed for packing to take effect.  Supplemental infiltration of the septum, the turbinates, and the floor of the nose also accomplished with local anesthesia.

The concave fracture on the right side was first addressed with a Boise elevator.  Elevation was carried out with digital compression on the left side to close the now open nasal dorsum.  The nasal bones appear to correct reasonably well but of course the septum remained displaced to the left.  There was no ability with use of Boise elevator or the Ash forceps to reduce the septal fracture.  There was still, in essence, complete obstruction of the left side of the nasal airway.

A left hemitransfixion incision was made.  Elevation of the mucoperichondrium and mucoperiosteum was accomplished on each side of the septum.  The septum was severely twisted and was resting in the left side of the nose but was displaced off the maxillary crest.  Posteriorly, a portion of vomer and perpendicular plate was removed and the cartilaginous septum could now be aligned in a favorable midline position.  It rested directly then on the maxillary crest in the midline but the turbinates remained a significant issue in terms of obstruction.  Inferior turbinoplasties were carried out with the shaver.  Suction cautery was used to establish hemostasis and that in turn created some reasonable symmetry to the airway.  Because of the nasal stenosis, however, osteotomies were carried out with 7-mm osteotome above the attachment of the middle turbinate on each side and below the middle turbinate on each side as well.  Trivial bleeding ensued but the airway was now symmetrical.

The hemitransfixion incision was closed then with 5-0 chromic sutures.  Doyle splints were used to secure the septum in its new midline and favorable position.  Before the nasal dorsal splint was applied, a quick setting Denver splint was placed over the nasal dorsum to secure the nasal bones in a favorable position and had discharge plan later this a.m.  Office followup is anticipated if stable and doing well in 5 days for splint removal.

Thanks,
Susan


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## amitjoshi4 (Jun 20, 2008)

smcbroom said:


> I have a commercial claim and I think I have the first codes correct:
> 1. 21320
> 2. 30520?
> 3. 30140 50 52
> ...


 
Hi Susan, 

The codes will be as follows 

1 30140
2 21320
3 30465 (Patient has nasal stenosis).

 Look per CDR "The physician repairs a nasal vestibular stenosis using a variety of techniques. Separately reportable cartilage (e.g., auricular composite) graft may be used to support the cartilaginous skeleton and vestibular soft tissue scarring. In one external approach the physician makes an incision in the upper lateral cartilage, in another approach a "V" shaped cut may be made. In either case the incision is followed by an osteotomy of the medial aspect of the nasal bones. A spreader graft is placed to widen the nasal vestibule. The incision is closed or closed in a V-Y manner (lengthens the columella) with suture."

NCCI Edit - Code 30520 is a component of comprehensive procedure code 30465 that is not allowed even if appropriate modifier is present. 
Code 30520 is identified as part of another procedure on the claim, code 30465, coded on the same day, where the use of a modifier is not appropriate. Only code 30520 of the code pair is rejected; code 30465 is allowed.

Also i could not see turbinate reduction in Body of Report,its only mentioned in Procedure Performed.

If you find any new finding do share.

Thank You


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