Tinaer28
New
help please.... can he bill both 67450 and 21365? is there enough documentation to support the orbitotomy or should this be included in the 21365 as this states "multiple approaches" and he was already in the surgical site to repair the orbital zygomaticomaxillary complex.
Op note reads:
upper blepharoplasty incision ....sharp dissection carried out down to the level of lateral orbital rim....subperiosteal elevation performed to identify the fracture...dissection was carried out along the lateral orbital wall where comminution and fractures were encountered. Attention was then drawn to the lower lid where #15 blade was used to make an incision through the skin and through the orbicularis oculi. Sharp dissection was carried out down to the level of the orbital rim where the arcus marginalis was indentified. A malleable was used to retract the orbital septum and orbital fat. Electrocautery was used for division of the arcus marginalis. subperiosteal evlevation was carried out along the orbital rim for exposure of comminution of fracture fragments along the orbital rim. Attenion was then drawn to the mouth where electrocautery was used to make an upper buccal sulcus incision. Dissection in the submucosal plane was carried out down to the level of the maxilla. subperiosteal elevation was carried out superiorly and laterally along the lateral maxillary buttress and onto the zygoma. Electrocautery was used for release of the insertion of the masseter on to the malar eminence and zygomatioc arch.......once wide subperiosteal elevation was performed for all fractures, zygomatic arch reduction forceps inserted underneath the malar eminence with direct pressure and elevation, the malar eminence and zygoma were elevated anteriorly and placed back in anatomic reduction. anatomic reduction was confirmed along the lateral orbital wall, the lateral orbital rim, the inferior orbital rim and lateral maxillary buttress. Once all bony fragments were reduced, we began with fixation along the lateral orbital rim with 2 point of fixation superiorly and inferiorly and then along the inferior orbital rim with 2 points of fixaton medially and laterally to seperate the comminuted fragments. the fracture extends inferiorly into the infarorbital nerve foramina. After fixation of the infraorbital rim, periosteal dissection was carried out along the lateral orbital floor and lateral orbital wall. with the orbital exploration we found he had nice realignment of the communiion and therefore no orbital implants were placed. lastly plated the lateral maxillary buttress wtih L-shaped plate with at least 2 points fixation superior and inferior to all the fracture fragments...
Op note reads:
upper blepharoplasty incision ....sharp dissection carried out down to the level of lateral orbital rim....subperiosteal elevation performed to identify the fracture...dissection was carried out along the lateral orbital wall where comminution and fractures were encountered. Attention was then drawn to the lower lid where #15 blade was used to make an incision through the skin and through the orbicularis oculi. Sharp dissection was carried out down to the level of the orbital rim where the arcus marginalis was indentified. A malleable was used to retract the orbital septum and orbital fat. Electrocautery was used for division of the arcus marginalis. subperiosteal evlevation was carried out along the orbital rim for exposure of comminution of fracture fragments along the orbital rim. Attenion was then drawn to the mouth where electrocautery was used to make an upper buccal sulcus incision. Dissection in the submucosal plane was carried out down to the level of the maxilla. subperiosteal elevation was carried out superiorly and laterally along the lateral maxillary buttress and onto the zygoma. Electrocautery was used for release of the insertion of the masseter on to the malar eminence and zygomatioc arch.......once wide subperiosteal elevation was performed for all fractures, zygomatic arch reduction forceps inserted underneath the malar eminence with direct pressure and elevation, the malar eminence and zygoma were elevated anteriorly and placed back in anatomic reduction. anatomic reduction was confirmed along the lateral orbital wall, the lateral orbital rim, the inferior orbital rim and lateral maxillary buttress. Once all bony fragments were reduced, we began with fixation along the lateral orbital rim with 2 point of fixation superiorly and inferiorly and then along the inferior orbital rim with 2 points of fixaton medially and laterally to seperate the comminuted fragments. the fracture extends inferiorly into the infarorbital nerve foramina. After fixation of the infraorbital rim, periosteal dissection was carried out along the lateral orbital floor and lateral orbital wall. with the orbital exploration we found he had nice realignment of the communiion and therefore no orbital implants were placed. lastly plated the lateral maxillary buttress wtih L-shaped plate with at least 2 points fixation superior and inferior to all the fracture fragments...