ncsorice
Contributor
Help. I bill for ASC and am looking for some input on how to code this. I am thinking 21335, 30140 Rt, LT and 30420. Thoughts?
Initially, I performed an opened reduction of the nasal fracture. Osteotomy incisions were placed and also created using Cottle elevator, outlining lateral aspect of the nasal bone. The bone was osteotomized bilaterally, and the left nasal bone was outfractured, and the right nasal bone was partially infractured. Next, the Cottle hemitransfixion incision was placed on the right side. Anterior Cottle septum was identified. The mucoperichondrial flap was developed on the left side posteriorly. About 2 cm of the anterior septal cartilage was maintained because the patient has a very long nose. A crossover incision was placed posterior to the level of nasal aperture, and a deviated portion of the nasal cartilage and septum were removed. The mucoperichondrial flaps were secured together using 4-0 plain gut on the Keith needle.
Next, the inferior cartilaginous incision was placed on the right side. The nasal dorsum was dissected and the knife was used to separate the upper lateral cartilages away from the septum. Middle vault grafts were fashioned and secured using 5-0 PDS stitch. Then, the upper lateral cartilage was reattached to the septum and middle vault at that point is wide and is repaired. Next, the inferior turbinates were resected via submucous resection bilaterally by incising them at their anterior attachment, elevating mucoperiosteum posteriorly, and partially removing the turbinate bone with turbinate blade.
Next, the most posterior aspect of the nasal ala was infiltrated with lidocaine with epinephrine. Horizontal incision was placed on both sides, measuring about 3 mm. A tunnel was created laterally, and a graft was placed to provide flare to the lateral aspect of the ala to prevent any further collapse. At this point, the procedure was completed.
Thank you in advance.
Initially, I performed an opened reduction of the nasal fracture. Osteotomy incisions were placed and also created using Cottle elevator, outlining lateral aspect of the nasal bone. The bone was osteotomized bilaterally, and the left nasal bone was outfractured, and the right nasal bone was partially infractured. Next, the Cottle hemitransfixion incision was placed on the right side. Anterior Cottle septum was identified. The mucoperichondrial flap was developed on the left side posteriorly. About 2 cm of the anterior septal cartilage was maintained because the patient has a very long nose. A crossover incision was placed posterior to the level of nasal aperture, and a deviated portion of the nasal cartilage and septum were removed. The mucoperichondrial flaps were secured together using 4-0 plain gut on the Keith needle.
Next, the inferior cartilaginous incision was placed on the right side. The nasal dorsum was dissected and the knife was used to separate the upper lateral cartilages away from the septum. Middle vault grafts were fashioned and secured using 5-0 PDS stitch. Then, the upper lateral cartilage was reattached to the septum and middle vault at that point is wide and is repaired. Next, the inferior turbinates were resected via submucous resection bilaterally by incising them at their anterior attachment, elevating mucoperiosteum posteriorly, and partially removing the turbinate bone with turbinate blade.
Next, the most posterior aspect of the nasal ala was infiltrated with lidocaine with epinephrine. Horizontal incision was placed on both sides, measuring about 3 mm. A tunnel was created laterally, and a graft was placed to provide flare to the lateral aspect of the ala to prevent any further collapse. At this point, the procedure was completed.
Thank you in advance.