# how you codethis



## codedog (Dec 3, 2010)

would cpt code 68815  x2 and
68811 x4 
I think I MAY BE LOOKING IT IN TO MUCH ?

PREOPERATIVE DIAGNOSIS:  Bilateral epiphora associated with punctal stenosis.  The status of the nasolacrimal duct preoperatively was unknown.  
POSTOPERATIVE DIAGNOSIS:  Punctal stenosis.    
OPERATION:  Dilation of all four puncta with probing with lacrimal system, followed by intubation with silastic tubing both right and left lacrimal systems and with final punctoplasty both lower lids.  Any suggestions,I dont see a DCR 

PROCEDURE:
   has had good visual acuity.  Has a  status post cataract extraction, but complains of chronic irritation and tearing.  Examination reveals significant amounts of epiphora, and all four puncta are extremely stenotic.  I was unable to dilate them and intubate them in the office, as the exact status of his nasolacrimal duct was then known.  So it was elected to bring him to surgery in order to dilate and probe the lacrimal system, probably put tubing in and asses the nasolacrimal duct, thus doing a DCR or even a Jones tube, if needed.  
The patient was taken to the operating room, and there he was put under general anesthesia via endotracheal intubation, without incident.  The area around both eyes and his nose was then prepped, and draped in the usual oculoplastic manner.  Both right and left nares were then packed with gauze soaked in Neo-Synephrine.  Then examination was first turned to the right side.  
At this point, a punctal dilator was then used to dilate the inferior punctum, and it was easily probed with a 00 followed by a single 0 probe.  The superior punctum was dilated, and I was able to probe this superior system with a 00 Bowman probe.  It was somewhat difficult passing through the upper system, but I was fairly sure I got into the lacrimal sac.  
At this point, the system was irrigated with BSS which had been stained with fluorecin, and eventually I was able to recover the fluorecin in the nose with suction.  This thus indicated an open nasolacrimal duct, so at this point it was elected to intubate the upper lacrimal system and perform a punctoplasty.  
A pigtail probe was passed through the inferior punctum, and it was brought out through the superior punctum, without much difficulty.  A suture was then used through the eyelet of the pigtail probe and brought out through the entire system.  This was then sutured to a canalicular system which was then brought through the entire canalicular and sac system.  The tubing was then trimmed, and the suture which was preexisting in the lumen


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## preserene (Dec 9, 2010)

It appears as though DCR was not done but there seemed all the intended ground work was undertaken
He has done canaliculoplasty ( a plastic & reconstructive surgery) for canalicular stenosis; the insertion of bicanalicular stents to prevent permanent & complete closure of the canaliculi, has been performed- I would assign 68700 Plastic Repair of canaliculi.

Other procedures like probing, irrigation contrast medium injection as a test to confirm are also done and I think they could be considered as components of the repair procedure.
I believe that 68700 plastic Repair of canaliculi would answer for the procedures and if it was time consuming and more work involvement (it seems so), you can append mod-22 to it.
I think this could make more sense than going for that  than x 2 times. Please check whether this would work out.
This is just a suggestion and openion only


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