# dacrocystorhinostomy vs conjunctivorhinostomy



## vmounce (Dec 7, 2011)

I am confused.  Physician coded procedure below as 68750 and 68440.  Should this be 68720 and 68815 for the stent. Also, can I bill for the implant itself?
I appreciate any information on this

Vickie Mounce  

PREOPERATIVE DIAGNOSIS:  Left nasolacrimal duct obstruction.
POSTOPERATIVE DIAGNOSIS:  Left nasolacrimal duct obstruction.

PROCEDURE:  
1. Left upper and lower punctoplasties (CPT Code 68440).
2. Left dacryocystorhinostomy with Crawford tube placement (CPT Code 68750).

OPERATIVE PROCEDURE:  After informed consent was obtained, the patient was identified in the preoperative holding area as Freida Sams.  She was taken to the operating room and placed in the supine position.  General anesthesia was induced without complication.  After this, a local anesthetic and epinephrine mixture was injected into the left medial canthal region and Afrin soaked nasal pledgets were inserted into the left nostril.  The patient was then prepped and draped in the standard sterile ophthalmic fashion.  Of note, a time-out was performed prior to beginning this procedure, and after identifying the patient by her name, hospital number, and operative eye, all were in agreement.  Corneal eye shields were placed for both eyes preoperatively.  

A #15 Bard-Parker blade was used to make an incision over the anterior lacrimal crest.  Bovie electrocauterization was used to dissect down to the nasal bone.  Subperiosteal dissection was then carried out with a periosteal elevator.  

The Afrin soaked nasal pledgets were removed from the nose and a 10 mm x 15 mm osteotomy was created with a Kerrison rongeur.  Left and upper punctoplasties were performed with a sharp-tipped Westcott scissors.  An H-shaped incision was made in the nasal mucosal creating an anterior nasal mucosal flap.  The Crawford tube was inserted through the upper and lower puncta on the left side, through the canalicular system.  An H-shaped flap was also made in the medial wall of the lacrimal sac with sharp-tipped Westcott scissors.  The Crawford was pulled through this incision and out through the medial canthal incision.  Of note, there was mild purulent discharge noted while incising the lacrimal sac and this area was irrigated numerous times.  The Crawford tubing was then pulled through the osteotomy and out through the left nostril.  The left anterior nasal mucosal flap was sutured to the left anterior lacrimal sac flap with two interrupted 5.0 Vicryl sutures.  The medial canthal tendon was reapproximated with an interrupted 5.0 Vicryl suture and the medial canthal skin was closed with interrupted 6.0 chromic gut sutures.  

The corneal eye shields were removed from both eyes and Bacitracin ophthalmic ointment was applied over the surgical wounds.  Of note, the Crawford tube was tied off in the left nostril.  The Crawford tube was in good position postoperatively.  The patient was awakened from anesthesia without complications and transferred to the postoperative care unit.  

The case was discussed with the patient and her family.  They were advised that should there be a decrease in vision, swelling, redness, or any concerns to report immediately to the nearest emergency room.  They were also advised in terms of follow-up care and management.


----------



## vmounce (Dec 8, 2011)

Can someone help me with this coding scenario?  
See above.

Thank you,
vickie


----------

