# bit of a challenge-how to code...



## ncantello (Nov 11, 2008)

Patient with extensive history of left cheek lymphangioma status post greater than 80 surgical procedures.  Patient has developed a cellulitis in the left cheek and had most of the hardware for reconstruction removed.  Patient continued to have the left cheek cellulitis and abscess draining into the oral cavity.  Therefore, patient was brought today for exploration and removal of any retained foreign body.  Patient has history of chroninc left nasal congestion and inability to breathe.  Noted to have inferior turbinate hypertrophy and septal spur off to the left.  

Using short nasal speculm an incision was made with #15 blade along left anterior bulla of nasal septum.  A mucoperichondrial flap was raised with the Cottle elevator alon the floor of the septum and around the septal spur.  An incision was made thru the cartilage with #15 blade and spur was removed with a 2mm osteotome.  The mucoperichondrial flap was replaced and sutured in place.  Anterior wound then repaired.

The left inferior turbinate was then medialized.  An incision was made anteriorly using a nasal endoscopy.  Submucosal resection was then performed.  No perforations were identified during this procedure.  The inferior turbinate was then outfractured after the procedure.  A small Telfa pack was placed in the anterior nasal septum for drainage.  

Attention was then turned to the left buccal alveolar sulcus.  Using a Army-Navy retractor the fisula in the drainage area in the left cheek was noted.  An incision was performed with the #15 blade and foreign body material was identified.  The foreign body material was removed wih Blakesley forceps.  the wound was then debrided with grasping forceps and irrigated copiously with gentamicin irrigation.  The wound was then packed with Bactroban impregnated iodoform gauze.  Hemostasis was well controlled.  The specimen was sent to pathology for culture.  

Here's what I'm thinking:

Septoplasty                               30520   478.19, 470
Inferior Turb resection                 30140   478.0
Debridement of left cheek wound   11044   528.3, 729.6
Removal of foriegn body               20525   729.6

What do you think?


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