# Dacryocystorhinostomy



## vmounce

Doc did Dacryocystorhinostomy procedure but also mentions implant of perminent stent.  Should I bill for implant?  I appreciate any info.

Vickie Mounce


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## Jamie Dezenzo

was 68815 done?

CPT ASST

Year: 2009 

Issue: August 

Pages: 9&11 

Title: Coding Consultation: Questions and Answers 

Surgery–Eye and Ocular Adnexa

We received two questions pertaining to the following surgical intervention: Lacrimal puncta are dilated (68801), after which scissor punctoplasty is performed (68440). Canaliculi are probed and obstructions found within the canaliculi are dilated with the probe (68840). A dacryocystorhinostomy (DCR) is then performed (68720), after which silicone tubes are placed through the rhinostomy (included in DCR). Middle turbinate is partially
excised (30999).

Question 1o the more distal lacrimal tract procedures make this a conjuntivodacryocystorhinostomy (68750) or would they be separately coded, in addition to the DCR (68720) as above?

Answer:The procedural description provided is -definitely not a conjuntivodacryocystorhinostomy (68750). Moreover, a probing is always performed with a con-juntivodacryocystorhinostomy, and is thus, not
reported separately.

Question 2:Is the silicone intubation through the new nasolacrimal opening included in code 68720 or is there a different code for it, and can code 68815 possibly be used?

Answer:The silicone intubation is not included in the work description of code 68720,Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity).Although the additional work is minimal, it would be appropriate to separately report code 68815,Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent.

Hope it helps!


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## vmounce

Jamie

Hey.  Thanks for the reply.  The code is 68720.  I was told to bill for all implants so we can have a record and for also the ones that will pay.  Below is the op report.  If you could take a look.  I thought of using L8699 for implant.  Is this not correct?  If I understand the info you sent I should use 68815 in addition to 68720.  Does 68815 include the implant?  I think this is where I am confused.

  PREOPERATIVE DIAGNOSES:  
1.	Nasolacrimal duct obstruction.  
2.	Canalicular stenosis.
3.	Recurrent epiphora and chronic tearing.

POSTOPERATIVE DIAGNOSES: 
1.	Nasolacrimal duct obstruction.  
2.	Canalicular stenosis.
3.	Recurrent epiphora and chronic tearing.

PROCEDURE:   Complex dacryocystorhinostomy with placement of permanent stent.

INDICATION:  This patient underwent the previous DCR.  Because of a severe nosebleed afterwards her nose had to be packed.  She is now taken back to surgery to attempt reconstruction of her lacrimal drainage pathway.

OPERATIVE PROCEDURE: After reviewing the risks of this surgery which include failure, epistaxis, scarring, stent reaction and need for further surgery as well as loss of vision and other risks the patient was taken to the Operating Room Suite.  After obtaining general endotracheal anesthesia, Afrin nasal spray was placed along with cocaine intranasally and locally at the medial canthus.  The eyelids and face were then prepped and draped sterilely.  

A #15 blade was then used to recreate the DCR incision.  Dissection was carried out down to her rhinostomy and lacrimal sac flaps.  The flaps were carefully incised.  Dissection was then further carried out to explore her area of previous surgery.  Her rhinostomy was completely wide and  patent without any evidence of septal deviation or turbinate hypertrophy or scarring.  

Unfortunately, she had a plane of scar tissue over the common canaliculus.  The upper and lower puncta were dilated and large probes were placed to help create and open up a new common canaliculus.  All of this was complicated because of the tightness of the anatomy and previous scar tissue.  After opening her common canaliculus a Hurwitz stent was placed.  The flaps were then resutured and the incision was closed with 6-0 plain gut suture.  The stent was placed intranasally.  There was no bleeding encountered during this surgery.  A bolster and pressure patch were applied.   The patient was then transferred to the Recovery Room and discharged when stable.


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## pradeepmokarala@gmail.com

*dacryocystorhinostomy, mucous membrane graft to the fistula, excision of lacrimal fis*

Hi please suggest cpt for this following report.

PROCEDURES CARRIED OUT:
1.  Right dacryocystorhinostomy.
2.  Right mucous membrane graft to the fistula.
3.  Right excision of lacrimal fistula.

ANESTHESIA:  Procedure carried out under general anesthesia.

INDICATIONS FOR SURGERY:  This patient has a severe sinus infection, which required extensive sinus surgery and was admitted to the hospital.  This has resulted in scarring and loss of anatomical tissue between the orbit and the sinuses.  He has a chronic fistula between the nose and the eye.  He also has tearing from this eye with mucoid discharge.  This is being addressed today.

DESCRIPTION OF SURGERY:  A fully filled informed consent was obtained from the patient prior to the surgery.  The patient was taken to the operating room and identified by _____ on the way.  The patient was cleaned and draped in the usual sterile fashion.  Once general anesthesia had been induced, the right side of the nose was packed with cocaine.  An incision was made in the medial canthus and dissection was carried down to the periosteum and bony removal was carried out.  The lacrimal sac was very scarred and scar tissue was excised.  The lacrimal fistula was excised and adequate hemostasis was achieved by the careful use of cautery.  Next, membrane graft was harvested and inserted into the inner part to reconstruct the mucous membrane off the lateral wall of the nose and to close the fistula.  A similar closure was carried out via the transconjunctival approach with the conjunctivoplasty.  Adequate hemostasis was achieved by the careful use of cautery.  The patient was taken to recovery room in excellent condition.  Once this procedure had been completed, a monocular occlusive dressing was placed.
 thanks in advance


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