# Latera



## Jaslene08 (Jan 18, 2018)

Im having difficulty when billing Latera, I believe it should be billed w an unlisted code 30699. However, can this be billed separately from the Septoplasty procedure? please find example report attached. HELP! 


Procedure Performed:  Septoplasty,septum perforation repair Bilateral nasal valve repair                   		 
Bilateral submucousal turbinoplasty,Adenoidectomy

Description of Procedure(s):



The patient was transported to the operating room and placed on the operating

table in the supine position.  After general anesthesia with endotracheal

intubation, 4% cocaine pledgets were used in the nose  for hemostasis and

local anesthesia.  .   1% Lidocaine was injected into the bilateral columellar

areas and bilateral septal mucosa. Then the nose was examined, and noted a deviated septum to the right side

causing right obstruction. The deviation spur  is touching the right inferior

turbinate. A #15 blade was used to make a hemitransfixion incision at the right side

since the deviation is mainly on the right side.   After that, submucosal

mucoperichondrial dissection was carried down through the incision to separate

the mucopericondrium and the septal cartilage.  Dissection was continued

posteriorly and superiorly and inferiorly, elevating the mucoperichondrium

from the septal bone as well.   After that, a vertical incision was made with

a Dee knife anteriorly about 1 cm posterior to the caudal border of the septum

to leave a strut.  Then the mucoperichondrial and mucoperiosteal dissection

were carried out on the left side as well.



The septal cartilage and bone was totally separated with its covering mucosa.

Then the deviation was identified, which was to the right side posterior and

then the swivel knife was used to remove the cartilage deviation and Takahashi

forceps were used to remove the posterior and superior bony deviation.

Maxillary crest deviation was removed with an osteotome.





Septum perforation repair:  Because of the severe septum deviation, mucosa of

the septum are fragile.  Through and through perforation was found during

surgery.   After careful dissection of septum mucosa with the attached bone, a

pocket was made.  A 2x3 septum patch was inserted between septum and remaining

cartilage.  The removed nasal septum cartilage was inserted to overlap the

perforated area.   3-0 chromic suture was used to secure the patch.

Both nasal airways were very patent and then the 4-0 chromic mattress sutures

were used to close the septum.   4-0 chromic suture was used to suture the

incision on the right side and two Doyle splints were inserted into the nose

to keep the septum in place and both were covered by antibiotic ointment.  The

nylon suture was used to suture the anterior end of the splint together.

Between the skin and the stitch, a small 2x2 gauze was padded. The surgery was

finished.



Bilateral INFERIOR TURBINOPLASTY

1% Lidocaine was injected into inferior turbinate. Cudle knife was used to

make a cut at the anterior end of the turbinates.  A tunnel was made between

bone and mucosa.  Olympus Cauterized Shaver was inserted and partially removed

the submucosal soft tissue and bone. Wound was cauterized. There is visible

decrease in size of the turbinate.







Adenoidectomy: a  mouth gag was placed to expose the oral cavity, and a red

Robinson was inserted from the nose to mouth to hold the soft palate.  The

palate was palpated, and  there is no submucosal cleft palate. The suction

Bovie at a setting of 15 was used to cauterize the enlarged adenoid.  After

the adenoid was cauterized, complete hemostasis was achieved, and the surgery

was finished.  The mouth gag was removed, and the red Robinson was removed.



Latera Implant

After clean the nasal dorsum and nostril with betadine,  suction was used to

identify the side of nasal valve collapse.   Skin marker was marked on the

skin for insertion and end point.   Double crown hook was used to expose the

nostril.   Implant device was entered from the marked point and point toward

septum.  After 3-4 mm, needle was pointed to superior marker.   Lateral

implants were pushed in and the device was removed without difficult.  Steril

strip was applied to the dorsum of the nose.


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