# ENT surgery coding help



## shanhockyfan (May 25, 2011)

I am new to ENT coding but not codingin gengeral. I have a surgery that I am not sure what to do with. Any guidance would be very much appreciated. 

PROCEDURE PERFORMED: External rhinoplasty approach for repair of nasal septal perforation using bilateral septal flaps and temporalis fascia graft implant.
DESCRIPTION OF PROCEDURE: The patient was brought into the operating room, intravenous line was startd, routine monitoring was performed. General anesthesia was achieved through an oral tracheal tube. A v-like incision was marked across the columella, after which tissues of the nose were infiltrated with 1% xylocaine with 1:100,000 epinephrine and 4% cocaine packs placed inside the nose. The left temporalis area was shaved, prepped and draped in a routine fashion, after which an approximately 3 cm horizontal incision was made in the left temporalis area. Dissection was performed down to the temporalis fascia. A piece of temporalis fascia was harvested. Hemostasis was maintained with electrocautery. Closure was performed in multilayer fashion using 3-0 chromic and 4-0 nylon, the temporalis fascia was placed between 2 sterile tongue blades to desiccate and stiffen the graft. Attention was then turned to the nose where the v-like incision was made and a modified rim incision made along both sides. This allowed entry into the roof of the nose, which was exposed with sharp and blunt dissection. Then using a 15 blade, the anterior caudal end of the nasal septum was incised and bilateral flaps were elevated along both sides of the nasal septum. A small amount of tissue was removed from the peripheral rim of the perforation to freshen up the edges. After the bilateral septal flaps had been elevated, an incision was made superiorly on the right side to create a superiorly based bipedicle flap. On the left side, an incision was made along the floor of the septum to create an inferiorly based bipedicle flap. The flaps were then closed on both sides using 4-0 chromic suture, single interrupted sutures. Then from the external approach, the fascial graft was inserted to provide scaffolding for healing. The external skin of the nose was then draped back over. The columella and the columellar incision was closed with single interrupted sutures of 6-0 nylon and the modified rim incision closed with 5-0 chromic. Silastic sheeting was placed along both sides of the nose, secured with a transeptal suture of 3-0 chromic. Telfa packs were placed on both sides of the nose and then a Denver splint cast was applied externally. Estimated blood loss was approximately 30 cc. no complications were encountered. The procedure was then terminated, the patient taken to recovery room in stable condition. 

Please help. Thank you so much for you all of your input.


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## dimmitta (Jun 3, 2011)

This was a tough one! The codes that I would use would be 30420 for the Rhinoplasty with septal repair. I would also bill 20922 for the temporalis graft. This would be separately reportable since this is from a different body area.


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