# 30450



## jocoffey (Nov 18, 2014)

Our physician is billing cpt code 30450 and 21230(rib cartilage for dorsal
strut. Can 21230 be billed separately or is this included in the primary procedure?  Help!!!!!!!!


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## Candice_Fenildo (Nov 19, 2014)

I checked the CCI edits on these codes and they are not bundled. See below. 



*30450* 
Rhinoplasty, secondary; major revision (nasal tip work and osteotomies) 
No CCI edit; Before reporting code, check Medicaid and payer policies.


*Lay Terms*

A rhinoplasty is performed either through the open or closed approach. In an open approach, transfixion and infracartilagenous (rim) incisions are made. Closed approaches can be performed through a number of approaches such as an intercartilagenous incision, infracartilagenous incision, transfixion incision , etc.
*Clinical Responsibility*When the patient is appropriately prepped and anesthetized, the provider performs a rhinoplasty either through an open or closed approach. In an open approach, the skin of the nose is opened and raised. In a closed approach, small incisions such as a inter or infracartilagenous incisions are made. In either approach, the necessary changes are made to the bone, cartilage, and soft tissue as desired. The provider performs lateral and transverse osteotomies and the nasal bones are infractured. The nasal cartilaginous areas are then smoothed to straighten the nose and a graft may also be placed. A major nasal tip plasty is also done and this is performed by working on the lower lateral cartilage and narrowing it in the region of the dome by removing an equal portion of lateral and medial crura leaving the cartilage at the domal area. Finally, the wound is closed with transmucosal sutures, adhesive tapes, and splints. To make the nasal tip narrower in a closed rhinoplasty, cartilage can be removed from within the nose.


Primary repair: Any repair of an acute injury completed within the first 24 hours after the injury. It involves direct surgical correction of the injury.
Rhinoplasty: Cosmetic surgery of the nose; nasal reconstruction.
Secondary repair: A repair performed after two weeks from the date of the injury; it may include tendon grafts or other more complex procedures.





*21230* 
Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) 
No CCI edit; Before reporting code, check Medicaid and payer policies.

*CPT Assistant*


*Lay Terms*

The provider applies autogenous cartilage graft, taken from the patient?s own rib, to the face, including the chin, nose, or ear, to repair deformity due to fracture, injury, tumor resection, or congenital defect, such as saddle nose deformity.
*Clinical Responsibility*When the patient is appropriately prepped and anesthetized, the provider makes an incision over the rib area at a site chosen for harvesting the cartilage graft. He removes sufficient autograft material and closes the wound. To repair a saddle nose deformity, he carves the rib graft into two pieces, a dorsal graft and a columellar strut, which are interdigitated, or interlocked, to recreate an intact L shaped strut, which provides the normal shape of the nose. Once the graft is in the correct position, the provider sutures the dome of the nose over the graft with a transdomal suture, or suture over the nasal tip, closing the wound.


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