# Frontal recess



## codedog (Dec 14, 2011)

Stuck on this one, want to code this as

  1. 31255-50    473.8
  2 .31276-50    473.1  
for polypectomy think its included ?
  or dx  473.0, 473.2 473.1-notsure if 473.8 relates to all
                now 
doc office says  code it as a 31288  -A Sphenoidotomy
  not sure if 31288 is correct 
any suggestions ?

PREOPERATIVE DIAGNOSES:	Chronic pansinusitis involving the maxillary, ethmoid, frontal, and sphenoid sinuses.

POSTOPERATIVE DIAGNOSES:	Chronic pansinusitis involving the maxillary, ethmoid, frontal, and sphenoid sinuses.

PROCEDURES PERFORMED:	Bilateral total ethmoidectomy, bilateral frontal recess, polypectomy.

PROCEDURE IN DETAIL:   patient was given adequate preoperative sedation and brought to the operating room, where he was placed in a supine position and placed under general endotracheal anesthesia.  He was draped in the usual sterile fashion for surgery of the nose.  Examination of the external nose was unremarkable.  Examination of the internal nose was very abnormal.  His nasal septum was in the midline, however, there was evidence of previous multiple sinus surgeries.  His middle turbinates had been removed bilaterally causing a loss of landmarks in the nose.  The inferior turbinates were rigid size and the airway was opened, work had been done in the past on the inferior turbinates.  There was polypoid debris in previous ethmoidectomy, which had been done bilaterally.  The agger nasi area was particularly involved.  The maxillary medial wall had been completely removed on the right side and mostly completely removed on the left side.  There was polypoid debris and cobblestoning in the maxillary sinuses, but there was no medial wall.  Attention was turned to the ethmoid and using the surgical navigation system.  The agger nasi cells were exonerated and posterior ethmoid polyps were removed as well.  There had been extensive previous surgery in the ethmoid very close to the fovea ethmoidalis particularly posterior and very close to the optic nerve area.  These areas were very cautiously cleaned using the surgical navigation system as a guide.  All polyps were removed.  Great portion of this was done in the safe areas using a power microdebrider and manually in the more sensitive areas.  The frontal recess was obstructed with polyp bilaterally, this was worse on the left side, where some bone had to be removed and the agger nasi cells had to be exonerated to open the frontal sinus.  Thick mucoid debris was suctioned from the frontal sinus particularly on the left.  I had plans to open the sphenoid sinus, he has very odd-shaped sphenoid sinus with a pointed and very dense rostrum.  No natural ostium to the sphenoid could be located on either side as the bone was extremely dense there and ultimately this was just left alone.  With this done, no splints or wafers were used and the nose was thoroughly suctioned.  There was no bleeding.


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## bethh05 (Dec 20, 2011)

This is just my opinion, but there is no mention of placement of the scope if it was performed endoscopic. I know there is mention of the navigation system, but does that support endoscopic procedures?  The op note also states the bone was dense, so the sphenoid was "left alone", so I would not code the sphenoidotomy. The polypectomy is included with the tissue removal. Dx. 471.9 for the polyps. It looks like 31255-50 and 31276-50.


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## codedog (Dec 27, 2011)

thanks beth, thats what I did


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