# New coder news help with ENT



## ggparker14 (Nov 30, 2010)

Any suggestions on CPT codes would be greatly appreciated.

I have an op report for procedures:  1. Left endoscopic complete ethmoidectomy with removal of osteoma. 2. Left endoscopic maxillary anthrostomy. 3. Septoplasty. 4. Bilateral therapeutic outfracture of interior turbinates.

Op note reads: the patient was taken to the operating room and placed in the supine position after which general endotracheal anesthesia was obtained. This 57 year old white female had difficulty breathing through her nose secondary to a right septal deviation with a left caudal septal deviation. The mucosa was injected with 1% Xylocaine with epinephrine. A left hemitransfixion incision was created with a #15 blade and the mucoperichondrium and mucoperiosteum were elevated along the left side of the nose using the suction elevator. The bony cartilaginous septum was disarticulated and a portion of the quadrangular cartilage was removed to allow the remaining cartilage to swing back to the midline. A 1 cm strip of the caudal septum was crosshatched with the #15 blade. This allowed the septum to swing back to the midline. The mucoperichondrial and mucoperiosteal flaps were then coapted using 4-0 plain on a small Keith needle. The septoplasty was done for difficulty breathing through her nose, rather than for access to her ethmoid sinuses. Both inferior turbinates were then outfractured using the Boise elevator. The middle turbinate was injected with 1% Xylocaine with epinephrine. The turbinate was removed using the curved turbinate scissors under endoscopic control. The uncinate process was identified and removed using the Univeral backbiting forceps. This allowed access to the infundibulum. The natural ostia of the maxillary sinus was identified and joined to a large posterior accessory ostium using the Universal backbiting rongers. There was thick mucoid material in the lower maxillary sinus. The ethmoid bulla was removed using upbiting rongeurs and the edges taken down to the lamina papyracea using powered instrumentaiton. Dissection was then carried in a superior fashion using based laterally to the bone of the orbit. The mucosa was removed from the osteoma using a suction elevator. The thin bone of the lamina papyracea then cracked and a sub-periorbital plane developed. At this point, a small osteotome was used to free the osteoma superiorly and interiorly. The osteoma was then gently cracked back to free the bony tumor. The osteoma was removed and sent for pathological evaluation. The periosteum/periorbita was not violated and no orbital fat was encountered. Hemostasis was obtained by Afrin soaked Gelfoam. The Gelfoam was removed and the nose was then packed with Sinu-Knit soaked in sterile wter. A drip pad was applied andthe patient was awakened from general anesthesia, extubated, and returned to the recovery room in satisfactory condition.


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## capricew (Nov 30, 2010)

rhblevins61@yahoo.com said:


> any suggestions on cpt codes would be greatly appreciated.
> 
> I have an op report for procedures:  1. Left endoscopic complete ethmoidectomy with removal of osteoma. 2. Left endoscopic maxillary anthrostomy. 3. Septoplasty. 4. Bilateral therapeutic outfracture of interior turbinates.
> 
> Op note reads: The patient was taken to the operating room and placed in the supine position after which general endotracheal anesthesia was obtained. This 57 year old white female had difficulty breathing through her nose secondary to a right septal deviation with a left caudal septal deviation. The mucosa was injected with 1% xylocaine with epinephrine. A left hemitransfixion incision was created with a #15 blade and the mucoperichondrium and mucoperiosteum were elevated along the left side of the nose using the suction elevator. The bony cartilaginous septum was disarticulated and a portion of the quadrangular cartilage was removed to allow the remaining cartilage to swing back to the midline. A 1 cm strip of the caudal septum was crosshatched with the #15 blade. This allowed the septum to swing back to the midline. The mucoperichondrial and mucoperiosteal flaps were then coapted using 4-0 plain on a small keith needle. The septoplasty was done for difficulty breathing through her nose, rather than for access to her ethmoid sinuses. Both inferior turbinates were then outfractured using the boise elevator. The middle turbinate was injected with 1% xylocaine with epinephrine. The turbinate was removed using the curved turbinate scissors under endoscopic control. The uncinate process was identified and removed using the univeral backbiting forceps. This allowed access to the infundibulum. The natural ostia of the maxillary sinus was identified and joined to a large posterior accessory ostium using the universal backbiting rongers. There was thick mucoid material in the lower maxillary sinus. The ethmoid bulla was removed using upbiting rongeurs and the edges taken down to the lamina papyracea using powered instrumentaiton. Dissection was then carried in a superior fashion using based laterally to the bone of the orbit. The mucosa was removed from the osteoma using a suction elevator. The thin bone of the lamina papyracea then cracked and a sub-periorbital plane developed. At this point, a small osteotome was used to free the osteoma superiorly and interiorly. The osteoma was then gently cracked back to free the bony tumor. The osteoma was removed and sent for pathological evaluation. The periosteum/periorbita was not violated and no orbital fat was encountered. Hemostasis was obtained by afrin soaked gelfoam. The gelfoam was removed and the nose was then packed with sinu-knit soaked in sterile wter. A drip pad was applied andthe patient was awakened from general anesthesia, extubated, and returned to the recovery room in satisfactory condition.



i do not have my cpt book with me but believe you should bill 
31255-lt, 30520, 30930-rt, 30930-59,lt and 31267 lt

you will have to put in order of highest paying to lowest of course
i bill for a facility so if you bill for a physician your requirements may be different
also, i do not believe, you can bill the osteoma exc separately.  I think it is inclusive with the ethmoidectomy


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## ggparker14 (Dec 1, 2010)

thank you for your help.


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