# 30140-50 30520  31237 or 31267? Tia



## MELJNBBRB (Mar 24, 2015)

TIA,
MBS,CCS,CPC


Pre-op Diagnosis:
1.  Deviated nasal septum
2.  Turbinate hypertrophy
3.  Antral-choanal polyp, right side


Post-op Diagnosis:
Same


Procedure:
1.  Right endoscopic polypectomy with tissue removal from maxillary antrum
2.  Septoplasty (submucous resection)
3.  Bilateral inferior turbinate intramural cauterization


Summary:
General LMA anesthesia was established with the patient in the supine position on the operating table.  The septum and inferior turbinates were injected with 1% lidocaine plus 1:100,000 epinephrine.  Both nasal cavities were packed with Afrin-soaked cottonoids x several minutes while the midface was draped out in sterile fashion.


Endoscopic attention was directed to the right nasal passage.  A large antral-choanal polyp was identified and removed with a combination of sinus forceps and micro-debrider.  That portion of the polyp emanating from the infundibulum could not be effectively reached due to a prominent bony spur on the septum.  The right nasal passage was re-packed with Afrin-soaked cottonoids while the septal deviation was addressed.


A hemitransfixion incision was made inside the left nostril.  Ipsilateral mucosa was widely elevated along septal cartilage and bone, including the maxillary crest.  The bony-cartilaginous junction was carefully disarticulated along the vomer/ethmoid plate and maxillary crest.  Through this separation the contralateral mucoperiosteum was also widely elevated such that the bony septum could be straddled with a speculum.  At this point, submucous resection of deviated cartilage and bone was performed, taking great care to preserve generous cartilage struts for nasal tip support.  The large bony spur described above was completely removed.  The septal wound was irrigated with saline at completion.  The hemitransfixion incision was repaired with interrupted 4-0 chromic sutures.  Small mucosal rents provided satisfactory septal drainage.


Endoscopic attention was re-directed to the right nasal passage.  Completion polypectomy was performed with forceps and micro-debrider, revealing a generous auto-antrostomy created by the polyp.  This allowed for endoscopic evacuation of all visible polypoid tissue from the antrum itself.  Repeated saline irrigations were used to facilitate polyp removal from the maxillary sinus.  The antrostomy was slightly enlarged in the process.  A portion of Nasopore was inserted between the middle turbinate and lateral wall to prevent adhesions there.  The Nasopore was injected with Kenalog.


Each inferior turbinate was cauterized lengthwise using the Dennis bipolar intramural probe.  Multiple passes were made on each side.  The nasal passages were irrigated with saline at completion.  Doyle airway splints were coated with antibiotic ointment and inserted on each side.  These were secured in place with a nylon stitch through-and-through the membranous septum.  A moustache dressing was placed at completion.  The patient tolerated the procedure well and was transferred to the recovery area in satisfactory condition, and without apparent complications.  Estimated blood loss, 40 mL.


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## MELJNBBRB (Mar 25, 2015)

anyone? tia


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## jackjones62 (Mar 26, 2015)

30520 - Septoplasty
31267 - 51 - Endoscopic Maxillary Antrostomy w/Tissue Removal
30802 - 51 - Bilateral Inferior Turbinate Intramural Cauterization

I am questioning the description in the op note of the Septoplasty (submucosal resection)?, is that what the surgeon dictated or should that have been part of the turbinate procedure descriptive, should it have read Bilateral Inferior Turbinate Submucosal Resection?

Jennifer
CT ENT


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